Evaluation of etiology and procedure safety in paediatric renal patients undergoing plasma exchange

Complications of Therapeutic Apheresis In Children With Kidney Disease Therapeutic apheresis (TA) is an extracorporeal treatment that selectively eliminates harmful substances or cells in the blood. It is an effective treatment in renal diseases as it is used in many different diseases, but information about side effects is insufficient. In this study, it was aimed to evaluate the complications encountered during the procedure in children with kidney disease who underwent therapeutic apheresis procedure. Method: The medical records of children with kidney disease (≤ 18 years old) who were treated with therapeutic apheresis between January 1th 2007 and August 31th 2022 in our department were reviewed retrospectively from the hospital medical record system. Those with missing data and non-nephrological diseases were excluded from the study. Results: 108 children, 51 boys (47.2%) with a median age of 14 years (1– 18) and median body weight of 38 kg (6–90) were included in the study. These patients underwent a total of 1214 sessions of apheresis, including 1147 sessions of therapeutic plasma exchange (TPE) and 67 sessions of immunoadsorption (IA). They were grouped according to their diagnosis as acute humoral rejection after kidney transplantation 65.9%, hemolytic uremic syndrome 14.6%, nephrotic syndrome 14.1%, glomerulonephritis 4.2% and desensitization before renal transplantation 1.2%. Of the total 1214 sessions, 58 4.8% developed 17 different complications and 53 sessions (%4.6) could not be completed due to these complications. The patients with plasma exchange group had more complications than that of IA group (5.1% vs. 0%, p=0,070). The incidence of complications was higher in patients aged 3–6 years compared to other age groups (p=0,031). No significant relationship was found between the underlying disease and the frequency of developing complications. Complication rates were similar between 111 the peripheral venous vascular tract and using central catheters or fistulas (7.6% vs. 4.4%, p=0,125). The frequency of complications was similar between sessions using fresh frozen plasma and those using albumin (5.3% vs. 1.2%, p=0,118). Multivariate analysis modeled on age and hemoglobin values found increased risk of complications with increased hemoglobin (Hb) value (OR 1,250, 95% CI 1.093– 1.429, p<0,001); The cutoff value of Hb for development of complications was calculated as 9.75 g/dL with a sensitivity of %59.1 and specifcity of %57.2 (AUC: 0.576, CI: 0.50 – 0.64, p=0.015). The most common complications were technical problems, followed by allergic reactions. Conclusion: Our study has shown that the most frequent complication related to therapeutic apheresis procedures in the research population is due to technical problems. The risk of complications has been observed to increase in patients aged between 3 and 6 years and in patients with hemoglobin levels above 9.75 g/dL. Keywords: Therapeutic Plasma Exchange, Immunoadsorption, Complication