Study of Centrifugal Therapeutic Plasma Exchange and Membrane Therapeutic Plasma Exchange; A Comparative Study

Therapeutic plasma exchange (TPE) involves removing the patient's plasma and replacing it with allogeneic plasma, colloid, or crystalloid. TPE is most commonly performed using either centrifugation devices or plasma filtration across high-permeability membranes. This study aims to compare centrifugation-based therapeutic plasma exchange (cTPE) versus membrane-based therapeutic plasma exchange (mTPE) in terms of performance, adverse events, and efficacy in removing inflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in patients indicated for TPE.

In this randomized, prospective, paired crossover trial, 20 patients undergoing TPE for various therapeutic indications were enrolled. Ten patients were randomly assigned online to receive the TPE technique as follows: the first session was administered by cTPE, and the second session was administered by mTPE 48 h later. The remaining 10 patients received their first TPE session with mTPE, and 48 h later, their second session was performed with cTPE. Before and after each session, a complete blood count, serum calcium, IL-6, and TNF-alpha levels were measured, along with an assessment of plasma removal efficiency (PRE).

Regarding the elimination of TNF-alpha, there was no significant difference between the two TPE techniques (p = 0.156). However, the cTPE technique demonstrated improved IL-6 elimination, longer priming, longer procedure times, and superior PRE (p = 0.028, < 0.001, 0.004, and < 0.001, respectively).

Compared to mTPE, cTPE technique yields more PRE and is more effective at removing cytokines, especially IL-6, though it takes more time.

ClinicalTrials.gov Identifier: NCT06652516.