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

Area of Science:

• Nephrology
• Hematology
• Critical Care Medicine

Background:

• Therapeutic plasma exchange (TPE) is a versatile treatment modality with demonstrated benefits across numerous organ systems.
• While often a last resort, TPE is crucial in life-threatening conditions requiring acute intervention.
• Recent trials have refined TPE indications, yet technological advances foster broader clinical use and new applications.

Purpose of the Study:

• To analyze the evolution of TPE indications over 27 years at a national referral center.
• To assess the changing role and safety profile of TPE in clinical practice.
• To evaluate the impact of new, selective therapies on TPE utilization.

Main Methods:

• Retrospective analysis of TPE procedures performed over 27 years.
• Inclusion of data from a national referral center covering 90-95% of TPEs in Croatia.
• Examination of patient demographics, including pediatric and geriatric populations.

Main Results:

• A significant increase in the number of patients and TPE procedures performed over the 27-year period.
• Despite evolving indications and newer therapies like LDL-apheresis, TPE utilization has grown.
• Increased treatment frequency in very young and elderly patients, suggesting diminished fear of complications and wider acceptance.

Conclusions:

• Therapeutic plasma exchange is a relatively safe and effective treatment when performed by experienced staff for appropriate indications.
• TPE continues to be a widely applicable and useful procedure, experiencing a resurgence in the 21st century.
• The procedure's utility persists despite the development of more selective therapeutic alternatives.