Successful renal transplantation in a patient with cold agglutinin disease.

Cold agglutinin disease is a rare cause of acute graft loss after renal transplantation. A 71-year-old female with end stage renal failure was diagnosed to have cold agglutinin disease when investigated for recurrent clotting of hemodialysis circuits. Kidney transplantation was a major challenge due to unavoidable exposure of the transplant kidney to cold temperatures. Large volume plasma exchange given pre-transplant and infusion of warm saline prior to anastomosis resulted in successful renal transplantation with good graft function despite initial delayed graft function. This challenging case illustrates the complete removal of cold agglutinin antibodies with therapeutic large volume plasma exchange. J. Clin. Apheresis 32:56-58, 2017. © 2016 Wiley Periodicals, Inc.