Double filtration plasmapheresis – 10-year pediatric experience as an alternative to plasma exchange

Maxted, Andrew P.; Connell, Roy; Hussain, Farida

doi:10.1016/j.transci.2020.102928

Cited by 7 publications

(9 citation statements)

References 15 publications

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“…With regard to the apheretic complications, only mild adverse events including symptomatic hypotension and mild allergy were observed during 9.1% of all the DFPP sessions. This incidence is similar to those reported in previously published reports (9,10). During DFPP treatment, serum albumin decreases as well as globulin.…”

Section: Discussionsupporting

confidence: 91%

Double filtration plasmapheresis for children with different types of critical kidney diseases: a single-center retrospective cohort study

Quan¹,

Chen²,

Yang³

et al. 2023

Transl Pediatr

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Background: Double filtration plasmapheresis (DFPP) was initially used to facilitate the conduction of ABO-incompatible renal transplantation. The applicability of DFPP has recently expanded to cover the removal of various antibodies in adults with immune-mediated diseases. However, DFPP is seldom used in children, with few reports addressing its efficacy and safety in this population. This study aimed to explore the efficacy and adverse effects of DFPP for pediatric patients with renal indications.Methods: Children who received DFPP between December 2017 and December 2020 at Tongji Hospital were retrospectively studied, and sub-grouped for analysis according to the types of disease. All children received 3 to 6 DFPP sessions within 2 to 3 weeks, and were assessed for clinical outcomes according to glomerular filtration rate, proteinuria and extra-renal symptoms. Pre-and post-DFPP plasma were collected to measure the levels of pathogenic autoantibodies, immunoglobulins, fibrinogen, albumin, calcium, etc. Inhospital complications were also recorded.Results: Totally there were 10 children receiving 44 sessions of DFPP, including 2 males and 8 females, with a median age of 11.2 years old (5-13 years) and a median weight of 42.1 kg (20-59 kg). Five patients were treated for systemic lupus erythematosus (SLE), three patients for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), one for C3 glomerulopathy and one for ABO-incompatible renal transplantation. Plasma autoantibodies decreased substantially by 93% and 89% in those with SLE and AAV after the last session, respectively. Complete or partial responses were achieved in 80%, 33.3%, 100% and 100% of patients with SLE, AAV, C3 glomerulopathy, and ABO-incompatible renal transplantation, respectively. The proportion of cumulative IgG, fibrinogen, and albumin removal at the end of the last sessions were 58.8%, 67.69%, and 14.05% respectively. The removal of calcium, potassium and creatinine were not statistically significant. A few episodes (4.55%) of hypotension were observed when fresh frozen plasma was used as the replacement fluid, and no bleeding nor severe anaphylaxis was noted. Conclusions:The efficacy and safety of DFPP treatment in children with SLE, AAV, C3 glomerulopathy and ABO-incompatible renal transplantation were described in the present study. DFPP is proven to be a safe apheresis method for children weighing more than 20 kg.

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Section: Discussionsupporting

confidence: 91%

Double filtration plasmapheresis for children with different types of critical kidney diseases: a single-center retrospective cohort study

Quan¹,

Chen²,

Yang³

et al. 2023

Transl Pediatr

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“…Besides neurological indications, the total number of 55 patients underwent 391 sessions of DFPP in our center and this number is higher than the previous reports 12 . Compared with TPE, the patients in DFPP treatment sessions had a lower decrease in albumin levels like reported before 1,13 .…”

Section: Discussionsupporting

confidence: 56%

Comparison of Therapeutic Plasma Exchange and Double Filtration Plasmapheresis: Five Year Experience of Nephrology Unit

Bek¹

2021

Dicle Tıp Dergisi

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The aim of the study was to evaluate the outcomes and characteristics of therapeutic plasma exchange (TPE) and double filtration plasmapheresis (DFPP) in one center. Method:The data of cases treated with therapeutic plasmapheresis at the university hospital between 2007 and 2012 were retrospectively analyzed. 445 TPE and 391 DFPP sessions were done totally.Results: In the 5.5 years, in 116 cases 445 TPE and 391 DFPP sessions were done. The mean age was 46.61±16.83 years. There were 49 female and 67 male patients. Guillain-Barre syndrome ( 8.6%) was the commonly encountered indication for neurological diseases, glomerulonephritis ( 25%) was the leading indication for the renal-related diseases. Skin involvement due to diabetes mellitus (13.8%) and Pemphigus Vulgaris (5.2%) were the dermatological diseases. Complication rates were similar between DFPP and TPE sessions (p= 0.411). Conclusion:TPE and DFPP are safe and vital membrane separation techniques used as a treatment for a wide spectrum of diseases. These treatments can be safely done in hemodialysis units intensive care units and DFPP should be considered for the therapy refractory neurological diseases.

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“…Clinical outcomes are comparable to those of PLEX. 50 IA allows more profound antibody removal with efficiency exceeding that of PLEX. It might have a role in patients with very high anti-GBM antibody levels or those with persistence of anti-GBM antibodies despite PLEX therapy.…”

Section: Management Strategiesmentioning

confidence: 99%

Epidemiology, Impact, and Management Strategies of Anti-Glomerular Basement Membrane Disease

Asim¹,

Akhtar²

2022

IJNRD

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Anti-glomerular basement membrane (anti-GBM) disease is a rare but serious autoimmune disease, which is characterized by the development of pathogenic antibodies to type IV collagen antigens in the glomerular and alveolar basement membranes. This results in rapidly progressive glomerulonephritis (GN), alveolar hemorrhage, or both. A variety of environmental factors can trigger the disease in genetically predisposed patients. Temporal associations with influenza, SARS-CoV-2 infection, and COVID-19 vaccination have been described although there is insufficient evidence to suggest causality. Anti-GBM disease accounts for approximately 20% of the cases of rapidly progressive GN cases secondary to crescentic GN, but is an uncommon cause of end-stage kidney disease. Early diagnosis by detection of circulating antibodies, increased awareness of atypical as well as complex clinical variants of the disease, and combined therapy with immunosuppression and plasma exchange has improved the prognosis of patients with this potentially fatal disease. Progress has been hampered by the rarity of anti-GBM disease, but new agents and therapeutic regimens are emerging.

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Double filtration plasmapheresis – 10-year pediatric experience as an alternative to plasma exchange

Cited by 7 publications

References 15 publications

Double filtration plasmapheresis for children with different types of critical kidney diseases: a single-center retrospective cohort study

Double filtration plasmapheresis for children with different types of critical kidney diseases: a single-center retrospective cohort study

Comparison of Therapeutic Plasma Exchange and Double Filtration Plasmapheresis: Five Year Experience of Nephrology Unit

Epidemiology, Impact, and Management Strategies of Anti-Glomerular Basement Membrane Disease

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