Therapeutic Plasma Exchange: Indications and Outcomes. Single-Center Registry

Abstract

Introduction: Therapeutic plasma exchange is used to manage immune-mediated diseases as early as 1970th. Nevertheless, the evidence beyond the therapeutic indication is still anecdotal and depends on observational data and national registries from different parts of the world. Aim of the Study: To review the use of therapeutic plasma exchange (TPE) to manage different conditions in the Dubai Hospital-nephrology department and benchmark against standard indications categories by American Society of Apheresis (ASFA) guidelines.
 Methods: The study included all adult patients who performed TPE in Dubai Hospital during 24 months period from January 2017 until December 2019. Patient demographics, indications, anticoagulation used, the number of sessions, duration of hospitalization, ICU admission, mortality outcome, and occurrence of procedure-related complications were included. 
 Results: During the 24 months, 142 TPE sessions were performed for 33 registered patients (an average of 4.3 sessions/patient). The most common indications for TPE use in our registry were nephrology-related indications in 119 sessions (85%), while non-nephrology indications contributed for 21 sessions (15%). Among Nephrology related Indications, Thrombotic Thrombocytopenic purpura was the most common indication (47.8%), followed by post kidney transplantation (21%), while non-Nephrology-related indications were mainly for pancreatitis with Hypertriglyceridemia (9.2%). Complications arose in 2 sessions (1.4%), and mortality occurred in one (3%) critically ill patient related to non-procedure consequences and the severity of the underlying disease. 
 Conclusion: Our registry data confirm the safety of therapeutic plasma exchange in a professional, well-equipped nephrology setting when used for proper evidence-based indications with a lower rate of morbidity and mortality.