344: THIRTY YEARS OF SOLVENT/DETERGENT-TREATED PLASMA FOR TRANSFUSION IN CRITICALLY ILL PATIENTS

Abstract

Introduction: OctaplasLG (Octapharma AG, Switzerland) is a solvent/detergent (S/D)-treated plasma preparation made from pooled fresh frozen plasma (FFP). First used in 1989 as an FFP alternative, S/D plasma was developed to increase pathogen safety in treating acquired coagulation factor deficiencies during active bleeding, bleeding prevention, and therapeutic plasma exchange (TPE). Here, we review published literature on the efficacy, safety, and cost effectiveness of S/D plasma. Methods: Medline (PubMed) and Google Scholar were searched for articles reporting “octaplas” or “octaplasLG” efficacy and/or safety in clinical settings. Results: Efficacy/safety was shown for multiple indications in different patient groups, such as cardiac surgery (n=125/117 adult/pediatric patients receiving S/D plasma), liver disease (n=30/20), liver transplantation (n=269/5), hemodilution/blood loss (n=47 adults), obstetrics/gynecology (n=38 adults), and TPE (n=167/41), as well as in 162 critically ill neonates/pediatric patients. Studies demonstrated S/D plasma could improve standard coagulation markers comparable with FFP and was also associated with greater endothelial protection. S/D plasma had lower incidences of allergic and febrile non-hemolytic transfusion reactions, and transfusion-associated circulatory overload compared with FFP, and almost no confirmed cases of transfusion-related acute lung injury reported after >13 million units transfused. Studies suggested S/D plasma was more cost-effective than FFP due to lower risk of transfusion-related complications. Literature results showed some countries have replaced FFP with S/D plasma to improve plasma safety. A new freeze-dried form has been recently developed with similar biochemical quality to S/D plasma, and is of particular interest for pre-hospital settings, e.g., trauma, where rapid reconstitution/flexible storage improves logistics/utilization. Conclusions: Available evidence from 30 years of global use indicates that S/D plasma is an efficacious alternative to FFP in adult/pediatric patients for multiple indications, with a favorable safety profile. The clinical utility of S/D plasma is also expanding, with the freeze-dried form having the potential to further improve patient outcomes and reduce costs.