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Therapeutic plasma exchange in autoimmune diseases: a retrospective study in a tertiary pediatric hospital in Mexico
Héctor Menchaca-Aguayo1, Deshire Alpízar-Rodríguez2, Candy León-Rodríguez1
1Pediatric Rheumatology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
Insights
Therapeutic plasma exchange (TPE) is safe and effective for pediatric autoimmune diseases. Mortality in children undergoing TPE is linked to longer disease duration, not the procedure itself.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Critical Care Medicine
Background:
- Autoimmune diseases in children can be severe and life-threatening.
- Therapeutic plasma exchange (TPE) is an extracorporeal treatment used for various autoimmune conditions.
- Limited data exists on TPE use and outcomes in pediatric autoimmune diseases in Mexico.
Purpose of the Study:
- To describe the utilization and associated mortality factors of TPE in pediatric patients with autoimmune diseases.
- To evaluate the safety and efficacy of TPE in a tertiary pediatric hospital setting.
- To identify predictors of mortality in children undergoing TPE for autoimmune conditions.
Main Methods:
- Retrospective cross-sectional study conducted at the Hospital Infantil de México Federico Gómez.
- Inclusion criteria: patients under 18 years old with autoimmune diseases undergoing TPE between 2022 and 2025.
- Data collected: demographics, clinical characteristics, TPE details, laboratory results, clinical response, and mortality. Statistical analysis performed.
Main Results:
- Forty-one pediatric patients were included, with systemic lupus erythematosus (SLE) and autoimmune encephalitis being the most common indications for TPE.
- Overall, 85.4% of patients achieved complete or partial remission, and TPE was generally well-tolerated with few adverse events.
- Mortality rate was 14.6%, with all deaths attributed to sepsis. Longer disease duration was a significant predictor of mortality (OR 1.06; 95% CI 1.01-1.14; p=0.04).
Conclusions:
- Therapeutic plasma exchange (TPE) is a safe and beneficial treatment for severe autoimmune diseases in children.
- Mortality associated with TPE in this cohort was primarily driven by disease duration and sepsis, rather than the TPE procedure itself.
- The findings highlight the importance of early intervention and management of sepsis in pediatric patients undergoing TPE for autoimmune conditions.
Objective:
To describe the use and mortality-associated factors of therapeutic plasma exchange (TPE) in children with autoimmune diseases at a tertiary pediatric hospital in Mexico.
Methods:
Retrospective cross-sectional study including patients under 18 years old with autoimmune diseases who underwent TPE between 2022 and 2025 at the Hospital Infantil de México Federico Gómez. Demographic, clinical, therapeutic, and laboratory data were analyzed. Clinical response and mortality-associated factors were assessed.
Results:
Forty-one patients were included (68% female; median age: 12 years). The most frequent indications for TPE were systemic lupus erythematosus (SLE) (56.1%) and autoimmune encephalitis (14.6%). Other diagnoses included macrophage activation syndrome (MAS) (n = 3), overlap syndromes (n = 3), juvenile dermatomyositis (n = 2), and single cases of ANCA-associated vasculitis, Takayasu arteritis, antiphospholipid syndrome (APS), and Kawasaki disease. Complete or partial remission was achieved in 85.4% of cases, with variable responses depending on the underlying condition. TPE was well tolerated, with few adverse events. Overall mortality was 14.6% (n = 6), all due to sepsis (p < 0.001). Deceased patients had higher pre-TPE levels of CRP, procalcitonin, and ferritin, though not statistically significant. Longer disease duration was significantly associated with increased mortality in both univariable (OR 1.05, 95% CI 1.01-1.10; p = 0.04) and multivariable analysis adjusted for age, sex, and SLE diagnosis (OR 1.06; 95% CI 1.01-1.14; p = 0.04). Among SLE patients without sepsis, MEX-SLEDAI scores improved significantly.
Conclusion:
TPE was safe and beneficial in children with severe autoimmune diseases. Mortality was related to disease duration rather than the procedure itself.
