Recent advances in therapeutic apheresis.

Abstract

Recent advances in therapeutic apheresis include technical improvements, new indications, and pathophysiological insights. A new device that adsorbs endotoxins onto immobilized human albumin from human whole blood was recently developed. In a prospective randomized controlled trial (endotoxin adsorber study EASY), apheresis-treated patients had more improved APACHE II scores than controls. In a prospective randomized trial, the Prosorba column containing immobilized staphylococcal protein A was tested against sham apheresis in patients with end-stage rheumatoid arthritis. A significant improvement occurred in 42% of the treated patients vs. 16% of the controls. Sudden hearing loss was treated in a prospective randomized trial by a single heparin-induced extracorporeal LDL precipitation (HELP) treatment in comparison with conservative therapy. In patients with elevated fibrinogen and/or low-density lipoprotein (LDL) cholesterol levels, HELP was significantly superior to 10 days of intravenous conventional treatment. Promising results were achieved in prospective randomized trials applying immunoadsorption in end-stage dilated cardiomyopathy and rheopheresis in age-related macular degeneration. In a noncontrolled trial, C4d-positive acute humoral rejection after kidney transplantation could be effectively treated by immunoadsorption. Finally, HELP apheresis was simplified by using new hardware (HELP-Futura). Direct adsorption of lipids (DALI)-LDL-apheresis was improved by testing DALI 1250 adsorbers with improved capacity. High-blood-flow DALI was shown to be safe and effective, with the advantage of reduced treatment time. Last but not least, a modification of dextran-sulfate cellulose LDL apheresis was developed for direct LDL hemoperfusion.