Centrifugal Therapeutic Plasma Exchange in Pediatric Patients: A Single-Center Case Series From Japan

Centrifugal therapeutic plasma exchange (cTPE) has been increasingly adopted worldwide; however, pediatric data remain limited, particularly in Japan. To evaluate the feasibility, procedural characteristics, and safety of pediatric cTPE in a single-center cohort. We retrospectively analyzed pediatric cTPE sessions performed between 2021 and 2025, assessing procedural characteristics, adverse events, and laboratory changes. Nineteen pediatric patients underwent cTPE. For procedural analyses, 84 non-extracorporeal membrane oxygenation (ECMO) sessions were included. Peripheral arterial-venous access was used in 76.2% of sessions and central venous access in 23.8%. Median exchange time was 95 min (interquartile range [IQR] 81-113), and median blood flow rate was 1.23 mL/kg/min (IQR 0.87-1.94). All planned sessions were completed (feasibility 100%). No hypotension requiring intervention or clinically significant bleeding occurred. Ionized calcium < 1.0 mmol/L requiring supplementation occurred in 3.6% of sessions. Allergic reactions occurred in 2.4% of sessions, both associated with fresh frozen plasma use. Median per-session reduction rates were 70.8% for IgG and 65.8% for fibrinogen (both p < 0.001). In an exploratory analysis of non-ECMO sessions, red blood cell priming was not associated with clinically meaningful differences in periprocedural laboratory changes after adjustment for patient size and blood flow rate. Pediatric cTPE was feasible and associated with infrequent adverse events while achieving substantial reductions in IgG and fibrinogen. These findings provide practical procedural data to inform pediatric cTPE implementation in clinical settings.