Indications and complications associated with centrifuge-based therapeutic plasma exchange - a retrospective review

Therapeutic Plasma Exchange (TPE) is an extracorporeal treatment modality used to manage certain conditions caused by plasma deficiencies, autoantibodies, alloantibodies, toxins, and immune complexes. We describe our experience of using TPE for various disease indications and associated complications.

This is a retrospective, single-center review of centrifuge-based TPE performed by the division of nephrology at a tertiary care academic center between July 2018 to June 2022. 1219 TPE treatments in 145 patients were included.

The most common indications for TPE were Antibody-Mediated Rejection (AMR) of a kidney transplant (20%), autoimmune encephalitis (16%), and neuromyelitis optica (11%). Rare indications for TPE included Chronic Relapsing Inflammatory Optic Neuropathy (CRION), AMR of a pancreas transplant, osmotic demyelination, and belatacept removal in the setting of COVID-19. The most common complications were depletion coagulopathy (47.6%), hypocalcemia (44.1%), and hypokalemia (36.6%). Rare complications included stiff person crisis and pseudohypertriglyceridemia. 31.7% of patients received TPE for conditions managed by nephrologists.

TPE is an extracorporeal treatment modality for managing various renal and non-renal diseases. The study demonstrated that 18.7% of the patients at our center received TPE for conditions in which its role is not yet established, suggesting the need for further research on the use of TPE. In addition, this study supports the necessity of nephrology training program to include education on TPE as almost one-third of the indications for TPE in our center were for conditions managed by nephrologists.