Therapeutic plasma exchange in clinical practice: long-term single centre experience

Therapeutic plasma exchange (TPE) is a powerful tool in the treatment of a whole host of diseases and there is hardly any organ for which TPE has not been shown to have some beneficial effects. In most instances, TPE is indicated only as a last resort treatment if all conservative measures have failed. However, there are lifethreatening conditions where TPE is the primary mode of acute treatment. Results from recent randomized prospective controlled trials caused a narrowing of the spectrum of indications for use of TPE, while advances in the various fields of medicine and technology have enabled wider clinical application of this procedure and generated several new indications. To define the current role of TPE, we retrospectively analysed changes in indications for TPE in our database, that contains information on all TPEs conducted during 27 years at University Hospital Centre Zagreb (a national referral centre for therapeutic apheresis, which covers approximately 90-95% of all TPEs performed in Croatia). The number of patients, including children and elderly people) who underwent this procedure and TPEs increased several-fold over 27 years of follow-up despite changes in the pattern of indications and the emergence of new, more selective therapeutic options (LDL-apheresis, immunoadsorption, etc.). With wider application of TPE, fear of its complications have diminished, which may be the reason for the more frequent treatment of very young children and very old patients. Our results derived from a large number of treatments indicate that TPE is a relatively safe method of treatment, providing it is carried out by experienced staff, and used for appropriate indications with all necessary precautions. Despite the development of more selective methods, TPE is still a widely applicable and useful procedure, possibly experiencing a renesance in this century.