AUTHOR=Taylan Christina , Schaaf Anne , Dorn Corina , Schmitt Claus Peter , Loos Sebastian , Kanzelmeyer Nele , Pape Lars , Müller Dominik , Weber Lutz T. , Thumfart Julia 

TITLE=Safety of Therapeutic Apheresis in Children and Adolescents

JOURNAL=Frontiers in Pediatrics

VOLUME=10

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.850819

DOI=10.3389/fped.2022.850819

ISSN=2296-2360

ABSTRACT=<sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>Children and adolescents (<italic>n</italic> = 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.</p></sec><sec><title>Results</title><p>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 non-specific (nausea, headache). IA was better tolerated than PE. Complications were reported in 9.5% (<italic>n</italic> = 163) of the IA versus 12.1% (277) of the PE sessions (<italic>p</italic> &lt; 0.001). When considering different types of complications, significantly more non-specific/non-allergic events (<italic>p</italic> = 0.02) and allergic reactions occurred in PE sessions (<italic>p</italic> &lt; 0.001). More complications occurred with PE, when using fresh frozen plasma (16.2%; <italic>n</italic> = 145) in comparison to human albumin (14.5%; <italic>n</italic> = 115) (<italic>p</italic> &lt; 0.001).</p></sec><sec><title>Conclusions</title><p>Therapeutic apheresis 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.</p></sec>