OP70 – 2417: Plasma exchange (PLEX) in pediatric neurologic diseases: Assessment of safety and efficacy

Abstract

Objective We aim to assess the indication, safety and outcome of PLEX in pediatric patients with neurologic diseases. Methods Retrospective cohort study of consecutive patients seen in the dialysis and apheresis clinic of a tertiary care center between April 2007 and March 2013. Included were all pediatric patients treated with PLEX for an underlying neurologic disease. Adverse events (AE) were recorded according to the Common Terminology Criteria for Adverse Events classification. The key neurological deficit was graded as none, mild (fully ambulatory, no impact on activities of daily living (ADL)), moderate (limiting ambulation and/or ADL), and severe (wheelchair/bed ridden and/or ventilated), assessed at beginning/end of PLEX, at discharge from the acute care facility and at last clinical encounter. Primary outcome was the neurological deficit at last clinical encounter. Results A total of 109 (48 female, 44%) patients received PLEX. Eighteen (12%; 13 female (72%)) had an underlying neurologic disease consisting of: demyelinating (10), antibody-associated (2), other inflammatory neurologic diseases (6). Indication for PLEX was failure of first line treatment in all but one patient. Median (range) age at PLEX was 10.8 years (0.8–17.9 years). The key neurological deficit at PLEX start was severe in 15 (83%) and moderate in three (17%) patients. A total of 39 AE were recorded, consisting of hypotension (8), allergic reaction (3), anemia (15), thrombosis (2) and hypocalcemia (11). Twelve (31%) AE were graded as severe. At discharge from the acute care facility, six patients (33%) were ambulatory with support. At last clinical encounter after a median (range) follow up time of 2.0 years (0.3–6.6 years), the neurological deficit was none/mild in ten patients (59%). Conclusion For pediatric patients with severe inflammatory neurologic diseases PLEX is a safe treatment option. One third showed early improvement and almost 60% regained independent ambulation over the follow up period.