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

Fabio Paglialonga, Claus Peter Schmitt, Rukshana Shroff, Karel Vondrak, Christoph Aufricht, Alan Rees Watson, Gema Ariceta, Michael Fischbach, Gunter Klaus, Tuula Holtta, Sevcan A. Bakkaloglu, Alexandra Zurowska, Augustina Jankauskiene, Johan Vande Walle, Betti Schaefer, Elizabeth Wright, Roy Connell, Alberto Edefonti

Research output: Contribution to journalArticle

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Abstract

Background: Few observations on apheresis in pediatric nephrology units have been published.

Methods: This retrospective study involved children ≤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 349 IA/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.

Original languageEnglish
Pages (from-to)103-111
Number of pages9
JournalPediatric Nephrology
Volume30
Issue number1
DOIs
Publication statusPublished - 2015

Fingerprint

Blood Component Removal
Nephrology
Plasma Exchange
Plasmapheresis
Pediatrics
Focal Segmental Glomerulosclerosis
Therapeutics
HLA Antigens
Hemolytic-Uremic Syndrome
Kidney Transplantation
Anticoagulants
Autoimmune Diseases
Heparin
Albumins
Retrospective Studies
Kidney
Membranes

Keywords

  • Double filtration plasmapheresis
  • Immunoadsorption
  • Pediatric apheresis
  • Plasma exchange
  • Therapeutic apheresis

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Paglialonga, F., Schmitt, C. P., Shroff, R., Vondrak, K., Aufricht, C., Watson, A. R., ... Edefonti, A. (2015). Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units. Pediatric Nephrology, 30(1), 103-111. https://doi.org/10.1007/s00467-014-2907-3

Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units. / Paglialonga, Fabio; Schmitt, Claus Peter; Shroff, Rukshana; Vondrak, Karel; Aufricht, Christoph; Watson, Alan Rees; Ariceta, Gema; Fischbach, Michael; Klaus, Gunter; Holtta, Tuula; Bakkaloglu, Sevcan A.; Zurowska, Alexandra; Jankauskiene, Augustina; Vande Walle, Johan; Schaefer, Betti; Wright, Elizabeth; Connell, Roy; Edefonti, Alberto.

In: Pediatric Nephrology, Vol. 30, No. 1, 2015, p. 103-111.

Research output: Contribution to journalArticle

Paglialonga, F, Schmitt, CP, Shroff, R, Vondrak, K, Aufricht, C, Watson, AR, Ariceta, G, Fischbach, M, Klaus, G, Holtta, T, Bakkaloglu, SA, Zurowska, A, Jankauskiene, A, Vande Walle, J, Schaefer, B, Wright, E, Connell, R & Edefonti, A 2015, 'Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units', Pediatric Nephrology, vol. 30, no. 1, pp. 103-111. https://doi.org/10.1007/s00467-014-2907-3
Paglialonga, Fabio ; Schmitt, Claus Peter ; Shroff, Rukshana ; Vondrak, Karel ; Aufricht, Christoph ; Watson, Alan Rees ; Ariceta, Gema ; Fischbach, Michael ; Klaus, Gunter ; Holtta, Tuula ; Bakkaloglu, Sevcan A. ; Zurowska, Alexandra ; Jankauskiene, Augustina ; Vande Walle, Johan ; Schaefer, Betti ; Wright, Elizabeth ; Connell, Roy ; Edefonti, Alberto. / Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units. In: Pediatric Nephrology. 2015 ; Vol. 30, No. 1. pp. 103-111.
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AU - Paglialonga, Fabio

AU - Schmitt, Claus Peter

AU - Shroff, Rukshana

AU - Vondrak, Karel

AU - Aufricht, Christoph

AU - Watson, Alan Rees

AU - Ariceta, Gema

AU - Fischbach, Michael

AU - Klaus, Gunter

AU - Holtta, Tuula

AU - Bakkaloglu, Sevcan A.

AU - Zurowska, Alexandra

AU - Jankauskiene, Augustina

AU - Vande Walle, Johan

AU - Schaefer, Betti

AU - Wright, Elizabeth

AU - Connell, Roy

AU - Edefonti, Alberto

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N2 - Background: Few observations on apheresis in pediatric nephrology units have been published.Methods: This retrospective study involved children ≤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 349 IA/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.

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KW - Plasma exchange

KW - Therapeutic apheresis

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