Prethymectomy plasmapheresis in myasthenia gravis

Abstract

Plasma exchange before thymectomy may decrease the time on mechanical ventilation (MV) and shorten the stay in the intensive care unit (ICU) for patients with myasthenia gravis (MG). This study evaluated the effects of prethymectomy plasmapheresis. A total of 29 myasthenic patients, 18 women and 11 men aged 20-73 years, were treated with double filtration plasmapheresis (DFP) for two to five consecutive sessions over a period between 2 and 21 days (mean 8.1 days) before transsternal thymectomy. Acetylcholine receptor antibody (AchRAb) titers, vital capacity (VC), maximal inspiratory pressure (Pimax), and MG score were measured before and after the course of DFP. Three outcome measures including duration of postoperative hospital stay, duration of ICU stay, and duration of MV were analyzed for correlation with clinical variables. The duration of MV ranged from 6 to 93 h, with a median of 21 h. The median ICU stay was one day and the median postoperative hospital stay was 10 days. A higher removal rate of AchRAb was associated with a shorter duration of ICU and postoperative hospital stay (P = 0.001 and 0.019, respectively). Postoperative hospital stay was strongly correlated with post-DFP Pimax (P = 0.010), and marginally correlated with pre-DFP VC (P = 0.047) and to a lesser extent with pre-DFP Pimax (P = 0.063). Univariate analysis using the log rank test revealed that removal rate of AchRAb <30% (P = 0.043) and pre-DFP Pimax <-60 cmH2O (P = 0.024) were significantly associated with prolonged ICU stay. Risk factors for prolonged postoperative stay included post-DFP Pimax <-60 cmH2O (P = 0.017), pre-DFP Pimax <-60 cmH2O (P = 0.031), and post-DFP VC < 1.0 L (P = 0.046). Our results confirmed the efficacy and safety of DFP in prethymectomy preparation for myasthenic patients.

Myasthenic crisis: Guidelines for prevention and treatment

“…The 1986 NIH consensus statement supported the use of PE, and no placebo controlled clinical trials have been conducted [61]. PE has shown benefit in MC, management of exacerbations and has become a part in presurgical/prethymectomy preparation [62] as well.…”

A Comparison of the Effectiveness of Intravenous Immunoglobulin and Plasma Exchange as Preoperative Therapy of Myasthenia Gravis

“…Yeh et al used double filtration plasma exchange in 29 patients prior to thymectomy demonstrating reduction in myasthenia gravis (MG) score, serum acetylcholine receptor antibody (AchRAb) levels, and improved vital capacity. 2 Immunomodulation with intravenous immunoglobulin (IVIG) has also showed efficacy in acute exacerbation of MG. 3 In 2007, Zinman reported results of a randomized placebocontrolled trial of IVIG in MG exacerbation confirming its efficacy. 4 A prospective comparison of the efficacy of immunomodulation using 3 courses of plasma exchange or IVIG 0.4 g/kg/day over 3-5 days showed no significant difference in the primary end point of myasthenic muscular score (MMS), and fewer side effects were reported in the IVIG group than in the PLEX group.…”

Scanning Electron Microscopy of “Rosa” Filter Elements From Hemofenix Apparatus, and of Blood in Membrane Plasmapheresis and Laser Irradiation

“…Наиболее эффективным лечебным мероприяти-ем при развитии миастенических и холинергиче-ских кризов является проведение обменного плаз-мафереза [5][6][7][8].…”