Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units

Background Few observations on apheresis in pediatric nephrology units have been published. Methods This retrospective study involved children [less than or equal to] 18 years undergoing plasma exchange (PE), immunoadsorption (IA), or double filtration plasmapheresis (DFPP) in 12 European pediatric nephrology units during 2012. Results Sixty-seven children underwent PE, ten IA, and three DFPP, for a total of 738 PE and 349IA/DFPP sessions; 67.2 % of PE and 69.2 % of IA/DFPP patients were treated for renal diseases, in particular focal segmental glomerulosclerosis (FSGS), hemolytic-uremic syndrome (HUS), and human leukocyte antigen (HLA) desensitization prior to renal transplantation; 20.9 % of PE and 23.1 % of IA/DFPP patients had neurological diseases. Membrane filtration was the most common technique, albumin the most frequently used substitution fluid, and heparin the preferred anticoagulant. PE achieved full disease remission in 25 patients (37.3 %), partial remission in 22 (32.8 %), and had no effect in 20 (29.9 %). The response to IA/ DFPP was complete in seven patients (53.8 %), partial in five (38.5 %), and absent in one (7.7 %). Minor adverse events occurred during 6.9 % of PE and 9.7 % of IA/DFPP sessions. Conclusions PE, IA, and DFPP are safe apheresis methods in children. Efficacy is high in pediatric patients with recurrent focal segmental glomerulosclerosis (FSGS), atypical hemolytic uremic syndrome (HUS), human leukocyte antigen (HLA) sensitization, and neurological autoimmune diseases. Keywords Pediatric apheresis * Therapeutic apheresis * Plasma exchange * Immunoadsorption * Double filtration plasmapheresis
Introduction Apheresis is a widely recognized therapeutic option in pediatric patients, even though the literature on the various forms of pediatric apheresis is mostly limited to single-center, retrospective studies [1-6]. [...]