Plasma-exchange in pediatric patients: a single-center experience

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Fabio Paglialonga1, Gianluigi Ardissino2, Silvia Consolo2

  • 1Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy - fabiopaglialonga@alice.it.

Minerva Pediatrica
|November 21, 2014
PubMed

Insights

Plasma exchange (PEX) is a safe and effective treatment for pediatric patients with atypical hemolytic uremic syndrome (aHUS) and recurrent focal segmental glomerulosclerosis (FSGS). PEX also benefits sensitized kidney transplant recipients.

Area of Science:

  • Pediatric Nephrology
  • Renal Replacement Therapies
  • Immunology

Background:

  • Plasma exchange (PEX) indications in pediatrics often rely on adult data.
  • A review of PEX treatments in a pediatric unit over six years was conducted.

Purpose of the Study:

  • To review pediatric plasma exchange (PEX) treatments and their outcomes.
  • To evaluate the efficacy of PEX in various pediatric renal and immunological conditions.

Main Methods:

  • 377 PEX sessions were performed in 38 pediatric patients (median age 12.1 years).
  • Indications included atypical hemolytic uremic syndrome (aHUS), focal segmental glomerulosclerosis (FSGS), antibody-mediated rejection (AMR) post-renal transplant (rTx), and pre-transplant hyperimmunization.
  • Various PEX techniques were employed, including double-needle, single-needle, and combinations with hemodialysis or ultrafiltration.

Main Results:

  • PEX showed high remission rates in aHUS (4/6 recurrences) and successful HUS relapse prevention post-rTx.
  • Partial remission was achieved in native kidney FSGS (1/4) but higher in recurrent FSGS post-rTx (6/6).
  • PEX combined with immunosuppression was effective in sensitized rTx recipients (2/4) but not chronic AMR. Two severe adverse events (anaphylaxis, hemorrhage) occurred.

Conclusions:

  • Plasma exchange (PEX) is a safe procedure in pediatric patients.
  • Pediatric patients with aHUS, recurrent FSGS, and sensitized kidney transplant recipients benefit from PEX-inclusive treatment strategies.
Abstract

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