Therapeutic Plasma Exchange in Pediatric Transplant and Organ Failure: Analysis of Indications, Adverse Events, and Clinical Outcomes.

Abstract

Objectives: Therapeutic plasma exchange has become an increasingly important extracorporeal therapy in pediatric intensive care and transplant settings. However, evaluations in large real-world pediatric cohorts of its effectiveness and safety across multiple indications remain limited. In this 5 -year single -center study, we provided our experience with therapeutic plasma exchange in critically ill children and assessed clinical outcomes, indications, and procedure -related complications.

Materials and methods: This retrospective observational study included 88 pediatric patients who underwent 702 therapeutic plasma exchange sessions in the pediatric transplant and nephrology intensive care unit of Başkent University Hospital (Ankara, Turkey) between December 2018 and December 2023. Indications were classified according to new American Society for Apheresis categories. We analyzed demographic data, indications, replacement fluids, treatment response, and adverse events.

Results: Median age of the 88 pediatric patients who underwent 702 therapeutic plasma exchange sessions was 7.5 years (range, 0 -18 y ), and 52.3 % of patients were male. Fresh frozen plasma was used in 89.8 % of sessions and albumin in 23.9 %. The most frequent indications for therapeutic plasma exchange were posttransplant hepatic dysfunction (36.4 % ) and acute or chronic liver failure (28.4 % ), followed by antibody -mediated renal disease (13.6 % ) and multiorgan failure or sepsis (8 % ). Overall, 73 of 88 patients achieved complete or partial improvement, corresponding to a favorable response rate of 82.9 %. Renal transplant-related indications demonstrated higher response rates compared with liver -related conditions (91 % vs 78.9 % ). No life-threatening or procedure -terminating complications occurred; minor adverse events included hypotension, fever, allergic reactions, and thrombosis.

Conclusions: Therapeutic plasma exchange is a safe and effective supportive therapy for critically ill pediatric patients across a wide range of indications. When performed in experienced centers with close monitoring, complication rates are low. Multicenter prospective studies are needed to establish standardized protocols and further clarify disease-specific outcomes.