Infection following therapeutic plasma exchange: A large-scale descriptive cohort study

Therapeutic plasma exchange (TPE) is a procedure done for a broad variety of indications in which plasma proteins, including immunoglobulins, are removed. Current literature evaluating the risk of infection following TPE is limited to small single center studies, specific care contexts, or single indications.

We conducted a descriptive retrospective cohort study using the TriNetX federated EHR network. Patients who underwent TPE were identified. Those with qualifying infection codes 30 days or 7 days prior to their TPE procedure were excluded. The primary outcome was a composite of "any serious infections" within 30 days of the index TPE, with further analysis of five individual infection types. Opportunistic fungal infections were also assessed.

Among 22,993 patients, the composite 30-day proportion of infection following TPE was 6.3% (95% CI, 6.0%-6.6%), with the most common infections being sepsis at 2.2% (95% CI, 2.1-2.4), pneumonia at 2.0% (95% CI, 1.9-2.2), and urinary tract infection at 2.3% (95% CI, 2.1-2.5). Findings were consistent in sensitivity analyses using a 7-day washout and by era of index TPE. The opportunistic fungal infection proportion at 30 days was infrequent, 1.1% (95% CI, 1.0-1.2). Kaplan-Meier analysis did not show pronounced peri-procedural clustering.

These hypothesis generating findings in a large cohort of over 22,000 patients covering various indications across multiple care settings are roughly consistent with prior literature and indicate further studies with comparator groups are needed to clarify whether TPE independently increases infection risk.