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Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units

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Abstract

Background

Few observations on apheresis in pediatric nephrology units have been published.

Methods

This retrospective study involved children ≤18 years undergoing plasma exchange (PE), immunoadsorption (IA), or double filtration plasmapheresis (DFPP) in 12 European pediatric nephrology units during 2012.

Results

Sixty-seven children underwent PE, ten IA, and three DFPP, for a total of 738 PE and 349 IA/DFPP sessions; 67.2 % of PE and 69.2 % of IA/DFPP patients were treated for renal diseases, in particular focal segmental glomerulosclerosis (FSGS), hemolytic-uremic syndrome (HUS), and human leukocyte antigen (HLA) desensitization prior to renal transplantation; 20.9 % of PE and 23.1 % of IA/DFPP patients had neurological diseases. Membrane filtration was the most common technique, albumin the most frequently used substitution fluid, and heparin the preferred anticoagulant. PE achieved full disease remission in 25 patients (37.3 %), partial remission in 22 (32.8 %), and had no effect in 20 (29.9 %). The response to IA/DFPP was complete in seven patients (53.8 %), partial in five (38.5 %), and absent in one (7.7 %). Minor adverse events occurred during 6.9 % of PE and 9.7 % of IA/DFPP sessions.

Conclusions

PE, IA, and DFPP are safe apheresis methods in children. Efficacy is high in pediatric patients with recurrent focal segmental glomerulosclerosis (FSGS), atypical hemolytic uremic syndrome (HUS), human leukocyte antigen (HLA) sensitization, and neurological autoimmune diseases.

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Author information

Authors and Affiliations

  1. Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda, 9, 20122, Milan, Italy

    Fabio Paglialonga & Alberto Edefonti

  2. Pediatric Nephrology, University Hospital for Pediatric and Adolescent Medicine, Heidelberg, Germany

    Claus Peter Schmitt & Betti Schaefer

  3. Renal Unit, Great Ormond Street Hospital for Children, London, UK

    Rukshana Shroff & Elizabeth Wright

  4. University Hospital Motol, Prague, Czech Republic

    Karel Vondrak

  5. Department of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria

    Christoph Aufricht

  6. Children’s Renal & Urology Unit, Nottingham Children’s Hospital, Nottingham, UK

    Alan Rees Watson & Roy Connell

  7. Pediatric Nephrology,, Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Gema Ariceta

  8. Hopital Hautepierre, Strasbourg, France

    Michael Fischbach

  9. Renal Unit, KfH Pediatric Kidney Centre, Marburg, Germany

    Gunter Klaus

  10. Department of Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland

    Tuula Holtta

  11. Department of Pediatric Nephrology, Gazi University Hospital, Ankara, Turkey

    Sevcan A. Bakkaloglu

  12. Gdansk University Hospital Medical School, Gdansk, Poland

    Alexandra Zurowska

  13. Renal Unit, Vilnius University, Vilnius, Lithuania

    Augustina Jankauskiene

  14. Department of Pediatric Nephrology, University Hospital, Ghent, Belgium

    Johan Vande Walle

Authors
  1. Fabio Paglialonga
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  2. Claus Peter Schmitt
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  3. Rukshana Shroff
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  4. Karel Vondrak
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  5. Christoph Aufricht
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  6. Alan Rees Watson
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  7. Gema Ariceta
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  8. Michael Fischbach
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  9. Gunter Klaus
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  10. Tuula Holtta
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  11. Sevcan A. Bakkaloglu
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  12. Alexandra Zurowska
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  13. Augustina Jankauskiene
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  14. Johan Vande Walle
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  15. Betti Schaefer
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  16. Elizabeth Wright
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  17. Roy Connell
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  18. Alberto Edefonti
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Corresponding author

Correspondence to Fabio Paglialonga.

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Paglialonga, F., Schmitt, C.P., Shroff, R. et al. Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units. Pediatr Nephrol 30, 103–111 (2015). https://doi.org/10.1007/s00467-014-2907-3

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  • DOI: https://doi.org/10.1007/s00467-014-2907-3

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