ESPN 54th Annual Meeting

ESPN 2022


 
Safety of therapeutic apheresis in children and adolescents
JULIA THUMFART 1 ANNE SCHAAF 1 CORINA DORN 2 CLAUS PETER SCHMITT 3 SEBASTIAN LOOS 4 NELE KANZELMEYER 5 LARS PAPE 6 DOMINIK MÜLLER 1 LUTZ T WEBER 2 CHRISTINA TAYLAN 2

1- CHARITé UNIVERSITäTSMEDIZIN BERLIN
2- UNIVERSITY HOSPITAL OF COLOGNE
3- UNIVERSITY HOSPITAL FOR PAEDIATRIC AND ADOLESCENT MEDICINE, HEIDELBERG
4- UNIVERSITY MEDICAL CENTRE HAMBURG-EPPENDORF
5- HANNOVER MEDICAL SCHOOL
6- UNIVERSITY HOSPITAL OF ESSEN
 
Introduction:

 Therapeutic apheresis (TA) is based on the principles of either removing dissolved pathogenic substances (e.g. antibodies) from the blood plasma or replacing plasma factors. It expands the therapeutic scope for a variety of diseases. Safety analysis in the pediatric field are scant. The aim of this analysis was to analyze specific complications of TA modalities - plasma exchange (PE) and immunoadsorption (IA) - in children and adolescents.

Material and methods:

 Children and adolescents (n=298) who had received TA from 2008 to 2018 in five pediatric nephrology centers were analyzed retrospectively. In total, 4.004 treatments (2.287 PE and 1.717 IA) were evaluated.

Results:

Indications for TA were mainly nephrological and neurological diseases. The three main indications were antibody-mediated graft rejection (13.4%), hemolytic uremic syndrome mainly with neurological involvement (12.8%), and AB0-incompatible transplantation (11.7%).

Complications developed in 440 of the 4004 sessions (11%), of which one third were nonspecific (nausea, headache). IA was better tolerated than PE. Complications were reported in 9.5% (n=163) of the IA versus 12.1% (277) of the PE sessions (p<0.001). When considering different types of complications, significantly more non-specific/non-allergic events (p=0.02) and allergic reactions occurred in PE sessions (p<0.001). More complications occurred with PE, when using fresh frozen plasma (16.2%; n=145) in comparison to human albumin (14.5%; n=115) (p<0.001).

Conclusions:

 TA in childhood and adolescence is a safe treatment procedure. IA showed a lower complication rate than PE. Therefore, IA may be preferably provided if the underlying disease pathomechanisms do not require PE.