{"title":"Safety and Efficacy of Therapeutic Plasma Exchange in Pediatric Non-Neurological Diseases.","authors":"Monika Miklaszewska, Magdalena Błasiak, Przemysław Korohoda, Ewelina Jarosz-Wójcik, Katarzyna Zachwieja, Karina Madej-Świątkowska, Dorota Drożdż","doi":"10.2147/IJNRD.S572328","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Therapeutic plasma exchange (TPE) is a recognized treatment in pediatric immune-mediated and toxicological disorders, though evidence remains limited. This study assesses the safety and efficacy of TPE in children with non-neurological diseases treated at a tertiary hospital over 27 years. We focused on non-neurological indications to avoid excessive data heterogeneity.</p><p><strong>Methods: </strong>This retrospective analysis included 97 children (51 nephrological, 46 non-nephrological), who underwent 380 TPE procedures between 1997 and 2023. Indications were categorized according to ASFA 2023 guidelines. Effectiveness was evaluated semi-quantitatively based on clinical and laboratory parameters up to 3 months post-treatment. Safety was assessed by incidence of adverse events (AEs), allergic AEs, and mortality.</p><p><strong>Results: </strong>The most common indication was thrombotic microangiopathy (TMA, 23.7%), followed by toxicological and hematological disorders. TPE was effective (complete or partial improvement) in 67% of patients; full recovery occurred in 25.8%. In the nephrology group, eGFR increased 3.8-fold by 3 months post-TPE. However, immunosuppressive therapy was used 7.7 times more often in this group. The non-nephrological group had a higher mortality (26.1% vs 9.8%), mostly due to multiple organ failure. Intensive Care Unit admission and ASFA III indications significantly decreased survival odds. Fresh-frozen plasma (FFP) - based TPE was associated with significantly more AEs and interventions compared to TPE without FFP. Over time, FFP use declined, with 100% of TPEs in 2023 performed without FFP.</p><p><strong>Conclusion: </strong>TPE is a safe and effective therapy in selected pediatric non-neurological conditions when performed in specialized centers.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"572328"},"PeriodicalIF":2.3000,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007957/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Nephrology and Renovascular Disease","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/IJNRD.S572328","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Therapeutic plasma exchange (TPE) is a recognized treatment in pediatric immune-mediated and toxicological disorders, though evidence remains limited. This study assesses the safety and efficacy of TPE in children with non-neurological diseases treated at a tertiary hospital over 27 years. We focused on non-neurological indications to avoid excessive data heterogeneity.
Methods: This retrospective analysis included 97 children (51 nephrological, 46 non-nephrological), who underwent 380 TPE procedures between 1997 and 2023. Indications were categorized according to ASFA 2023 guidelines. Effectiveness was evaluated semi-quantitatively based on clinical and laboratory parameters up to 3 months post-treatment. Safety was assessed by incidence of adverse events (AEs), allergic AEs, and mortality.
Results: The most common indication was thrombotic microangiopathy (TMA, 23.7%), followed by toxicological and hematological disorders. TPE was effective (complete or partial improvement) in 67% of patients; full recovery occurred in 25.8%. In the nephrology group, eGFR increased 3.8-fold by 3 months post-TPE. However, immunosuppressive therapy was used 7.7 times more often in this group. The non-nephrological group had a higher mortality (26.1% vs 9.8%), mostly due to multiple organ failure. Intensive Care Unit admission and ASFA III indications significantly decreased survival odds. Fresh-frozen plasma (FFP) - based TPE was associated with significantly more AEs and interventions compared to TPE without FFP. Over time, FFP use declined, with 100% of TPEs in 2023 performed without FFP.
Conclusion: TPE is a safe and effective therapy in selected pediatric non-neurological conditions when performed in specialized centers.
期刊介绍：
International Journal of Nephrology and Renovascular Disease is an international, peer-reviewed, open-access journal focusing on the pathophysiology of the kidney and vascular supply. Epidemiology, screening, diagnosis, and treatment interventions are covered as well as basic science, biochemical and immunological studies. In particular, emphasis will be given to: -Chronic kidney disease- Complications of renovascular disease- Imaging techniques- Renal hypertension- Renal cancer- Treatment including pharmacological and transplantation- Dialysis and treatment of complications of dialysis and renal disease- Quality of Life- Patient satisfaction and preference- Health economic evaluations. The journal welcomes submitted papers covering original research, basic science, clinical studies, reviews & evaluations, guidelines, expert opinion and commentary, case reports and extended reports. The main focus of the journal will be to publish research and clinical results in humans but preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies and interventions.
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