ESPN 50th Annual Meeting

ESPN 2017


 
Double filtration plasmapheresis – 10-year experience as an alternative to plasma exchange
ANDREW MAXTED 1 ROY CONNELL 1 FARIDA HUSSAIN 1

1- NOTTINGHAM CHILDRENS HOSPITAL RENAL AND UROLOGY UNIT, PART OF THE EMEESY NETWORK, QMC, NOTTINGHAM
 
Introduction:

Plasma exchange is a non-selective treatment for a number of conditions. It removes large-molecular weight molecules from the blood and is associated with risks of bleeding, infection and reaction to blood-products. Double filtration plasmapheresis (DFPP) provides a more specific antibody removal treatment, reducing the need for replacement albumin and other blood products. We have been using this therapy for 10-years and submit our experience.

Material and methods:

We retrospectively analysed the medical records of all patients in whom DFPP had been performed using the Infomed HF400.

Results:

In total, 30 patients were treated with DFPP. 11 of these following transplantation; of those 9 were for antibody-mediated rejection and 2 for recurrence of focal segmental glomerulosclerosis. 19 patients were treated for other conditions including; anti-GBM disease (5), MPGN disease, Wegener’s granulomatosis (3), Myasthenia Gravis, Familial Hypercholesterolaemia (2), Guillain-Barré disease, autoimmune limbic encephalitis, pre-ABO incompatible transplantation and Henoch-Schönlein purpura (1). In total, adequate data allowed analysis of 155 sessions of DFPP in 21 patients. Two patients with familial hypercholesterolaemia had >50 sessions, on different secondary filters and weren’t included.

At the time of treatment median age was 13.5 (2.2 – 19.2) and median weight 43.3kg (13.4 – 82.8). Patients had a median of 5 sessions (1-21).

Of the 6 transplant patients analysed, 1 recovered, 1 recovered with CKD stage 4 and the other 4 required dialysis within 3 months. We used previously published European data on efficacy end-points in non-transplanted patients and in our 15 patients; 2 showed “absent” response, 4 “partial” and 9 (60%) “complete” efficacy in their treatments.

One patient had a unit of cryoprecipitate, another had 1 blood transfusion; no other blood products were required. In total 29% of sessions required a fluid bolus.

Conclusions:

This study demonstrates that DFPP is a safe and effective method of antibody removal, without the risks of blood product replacement.