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Therapeutic plasma exchange in paediatric nephrology in Ireland

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Abstract

Background

Therapeutic plasma exchange (TPE) is utilised in the management of a limited number of paediatric renal conditions. Despite its widespread acceptance and advancements in the practice of apheresis, there remains a paucity of data pertaining to paediatrics. We present a large retrospective review of our cohort of paediatric patients undergoing TPE for renal indications, outlining their outcomes and complications.

Methods

A retrospective chart review was conducted for all patients (under 16 years) undergoing TPE for renal conditions between January 2002 and June 2019 in Ireland. Demographic and clinical data were extracted, with patients anonymised and stratified according to their pathology.

Results

A total of 58 patients were identified. A total of 1137 exchanges were performed using heparin sodium anticoagulation. The median age was 35.5 months (IQR 18–110 months). The leading indication was neurological involvement in Shiga toxin–producing Escherichia coli haemolytic uraemic syndrome (STEC-HUS) (n = 29). Complications (minor or major) occurred in 65.5% (n = 38) of patients, with most experiencing minor complications 58.6% (n = 34). Asymptomatic hypocalcaemia was the most common complication in 43.1% (n = 25).

Conclusions

Our experience of TPE, spanning 1137 exchanges, proved a safe, well-tolerated therapy. Most complications were minor, and with therapy conducted in specialised centres, there are very low levels of adverse events.

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Data availability

All data pertaining to this audit may be made available upon reasonable request to the corresponding author.

References

  1. Reddy S, Jahan A, Chaturvedi S, Agarwal I (2015) Plasma exchange for paediatric kidney disease—indications and outcomes: a single-centre experience. Clin Kidney J 8(6):702–707. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655793/

  2. Schwab P, Fahey J (1960) Treatment of Waldenström’s macroglobulinemia by plasmapheresis. N Engl J Med 263(12):574–579. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1879704/

  3. Hans R, Sharma R, Marwaha N et al (2015) Efficacy and safety of therapeutic plasma exchange by using apheresis devices in pediatric atypical hemolytic uremic syndrome patients. J Clin Apher 31(4):381–387. Available from: https://pubmed.ncbi.nlm.nih.gov/26212115/

  4. Fencl F, Vondrak K, Rosik T et al (2016) Recurrence of nephrotic proteinuria in children with focal segmental glomerulosclerosis: early treatment with plasmapheresis and immunoadsorption should be associated with better prognosis. Minerva Paediatr 68(5):348–354. Available from: https://pubmed.ncbi.nlm.nih.gov/26041001/

  5. Sartain S, Shubert S, Wu M, Srivaths P et al (2019) Therapeutic plasma exchange does not improve renal function in hematopoietic stem cell transplantation–associated thrombotic microangiopathy: an institutional experience. Biol Blood Marrow Transplant 25(1):157–162. Available from: https://pubmed.ncbi.nlm.nih.gov/30144562/

  6. Khandelwal P, Thomas C, Rathi B et al (2019) Membrane‐filtration based plasma exchanges for atypical hemolytic uremic syndrome: audit of efficacy and safety. J Clin Apher 34(5):555–562. Available from: https://pubmed.ncbi.nlm.nih.gov/31173399/

  7. Paglialonga F, Schmitt CP, Shroff R et al (2015) Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units. Pediatr Nephrol 30(1):103–111. https://doi.org/10.1007/s00467-014-2907-3. Epub 2014 Aug 20 PMID: 25135618

    Article  PubMed  Google Scholar 

  8. Michon B, Moghrabi A, Winikoff R et al (2007) Complications of apheresis in children. Transfusion. 47(10):1837–1842. Available from: https://pubmed.ncbi.nlm.nih.gov/17880609/

  9. Connelly-Smith L, Alquist CR, Aqui NA et al (2023) Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the writing committee of the American Society for Apheresis: the ninth special issue. J Clin Apher 38(2):77–278. https://doi.org/10.1002/jca.22043. PMID: 37017433

    Article  PubMed  Google Scholar 

  10. Common Terminology Criteria for Adverse Events (CTCAE) (Version 5) [Internet]. Ctep.cancer.gov. 2020 [cited 9 September 2020]. Available from: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf

  11. Goldstein SL (2012) Therapeutic apheresis in children: special considerations. Semin Dial 25(2):165–70. https://doi.org/10.1111/j.1525-139X.2011.01028.x. Epub 2012 Jan 25. PMID: 22277133

  12. Michon B, Moghrabi A, Winikoff R et al (2007) Complications of apheresis in children. Transfusion 47:1837–1842. https://doi.org/10.1111/j.1537-2995.2007.01405.x

    Article  PubMed  Google Scholar 

  13. Goss GA, Weinstein R (1999) Pentastarch as partial replacement fluid for therapeutic plasma exchange: effect on plasma proteins, adverse events during treatment, and serum ionized calcium. J Clin Apher 14(3):114–121. https://doi.org/10.1002/(sici)1098-1101(1999)14:3%3c114::aid-jca2%3e3.0.co;2-8. PMID: 10540365

    Article  CAS  PubMed  Google Scholar 

  14. Joseph C, Siddiqui S, Shah S et al (2020) Therapeutic plasma exchange: single-center experience in children with kidney disorders. Pediatr Nephrol. https://doi.org/10.1007/s00467-020-04744-8

    Article  PubMed  Google Scholar 

  15. Padmanabhan A, Connelly-Smith L, Aqui N et al (2019) Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the writing committee of the American Society for Apheresis: the eighth special issue. J Clin Apher 34(3):171–354. https://doi.org/10.1002/jca.21705. PMID: 31180581

    Article  PubMed  Google Scholar 

  16. Trachtman H, Austin C, Lewinski M, Stahl RA (2012) Renal and neurological involvement in typical Shiga toxin-associated HUS. Nat Rev Nephrol 8:658–669

    Article  CAS  PubMed  Google Scholar 

  17. Keir LS, Marks SD, Kim JJ (2012) Shigatoxin-associated hemolytic uremic syndrome: current molecular mechanisms and future therapies. Drug Des Devel Ther 6:195–208

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Melton‐Celsa AR (2014) Shiga toxin (Stx) classification, structure, and function. Microbiol Spectr 2:10.1128

  19. Keenswijk W, Raes A, De Clerck M, Vande Walle J (2019) Is plasma exchange efficacious in shiga toxin-associated hemolytic uremic syndrome? A narrative review of current evidence. Ther Apher Dial 23:118–125. https://doi.org/10.1111/1744-9987.12768

    Article  PubMed  Google Scholar 

  20. Remuzzi G, Misiani R, Marehesi D et al (1978) Haemolyticuraemic syndrome: deficiency of plasma factor(s) regulating prostacyclin activity? Lancet 2:871–872

    Article  CAS  PubMed  Google Scholar 

  21. Kielstein JT, Beutel G, Fleig S et al (2012) Best supportive care and therapeutic plasma exchange with or without eculizumab in Shiga‐toxin‐producing E. coli O104:H4 induced haemolytic‐uraemic syndrome: an analysis of the German STEC‐HUS registry. Nephrol Dial Transplant 27:3807e15

  22. Legendre CM, Licht C, Muus P et al (2013) Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med 368(23):2169–2181. https://doi.org/10.1056/NEJMoa1208981. PMID: 23738544

    Article  CAS  PubMed  Google Scholar 

  23. Costigan C, Raftery T, Carroll AG et al (2021) Neurological involvement in children with hemolytic uremic syndrome. Eur J Pediatr. https://doi.org/10.1007/s00431-021-04200-1

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. The Department for Paediatric Nephrology & Transplantation, Children’s Health Ireland, Dublin, Ireland

    Dermot M. Wildes, Conor Devlin, Caoimhe Suzanne Costigan, Tara Raftery, Mary Waldron, Niamh Dolan, Michael Riordan, Clodagh Sweeney, Maria Stack & Atif Awan

  2. The Department of General Paediatrics, Children’s Health Ireland, Dublin, Ireland

    Conor Hensey

  3. The Department of Haematology, Children’s Health Ireland, Dublin, Ireland

    Melanie Cotter

  4. The Department of Neurology & Clinical Neurophysiology, Children’s Health Ireland, Dublin, Ireland

    Bryan Lynch & Kathleen Mary Gorman

  5. School of Medicine and Medical Science, University College Dublin, Dublin, Ireland

    Bryan Lynch, Kathleen Mary Gorman & Atif Awan

  6. The Department of Paediatrics, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland

    Michael Riordan & Atif Awan

Authors
  1. Dermot M. Wildes
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  2. Conor Devlin
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  3. Caoimhe Suzanne Costigan
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  4. Tara Raftery
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  6. Mary Waldron
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  7. Niamh Dolan
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  8. Michael Riordan
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  9. Clodagh Sweeney
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  10. Maria Stack
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  11. Melanie Cotter
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  12. Bryan Lynch
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  13. Kathleen Mary Gorman
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  14. Atif Awan
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Contributions

Drs. Wildes, Awan, and Gorman conceptualised and designed the study, drafted, reviewed, and designed the manuscript. Dr. Devlin, Costigan, Raftery, and Hensey assisted with data collection and revision of the manuscript. Drs. Waldron, Dolan, Riordan, Sweeney, Stack, Cotter, and Lynch contributed to patient care and critically reviewed the manuscript for intellectual content. All authors reviewed and approved the final manuscript, as submitted.

Corresponding author

Correspondence to Dermot M. Wildes.

Ethics declarations

Ethical approval

Ethical approval for this study was provided by the CHI at Temple St, Research & Ethics committee (Approval number 21.027).

Conflict of interest

Professor Awan previously served on the Alexicon medical advisory board. All other authors declare that there are no relevant interests of a financial/non-financial nature.

Patient consent statement

No informed consent was obtained as patients are non-identifiable from the presented data in this retrospective study.

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Wildes, D.M., Devlin, C., Costigan, C.S. et al. Therapeutic plasma exchange in paediatric nephrology in Ireland. Ir J Med Sci 193, 1589–1594 (2024). https://doi.org/10.1007/s11845-023-03560-x

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  • DOI: https://doi.org/10.1007/s11845-023-03560-x

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