Therapeutic Apheresis: Is It Safe In Children With Kidney Disease?

Abstract

Therapeutic apheresis (TA) is already used in the treatment of various diseases in the field of nephrology. The aim of this study was to evaluate the frequency and types of complications that occur during TA in children with kidney disease. Method Records of children (≤ 18 years) who underwent TA between 2007 and 2022 were retrospectively reviewed. Children with missing data and those with a diagnosis of non-nephrological disease were excluded. Results A total of 1214 TA sessions, including 1147 therapeutic plasma exchange (TPE) sessions and 67 immunoadsorption (IA) sessions, were performed on 108 patients enrolled in the study. 47.2% of the patients were male and the mean age was 14 (1-18) years. Post-transplant antibody-mediated rejection (64.8%) and haemolytic uremic syndrome (14.8%) were the most common diagnoses indicating TA. Overall, 17 different complications occurred in 58 sessions (4.8%) and 53 sessions (4.6%) were not completed because of these. Technical problems accounted for 41.4%, allergic reactions 25.9% and citrate poisoning 5.2% of complications; the most common technical complication was inadequate flow (15.5%). The incidence of complications was higher in patients aged 3-6 years compared to other age groups (p=0.031). The primary disease, type of vascular access, and the rate of fresh frozen plasma/albumin use were similar between patients with and without complications ( p value 0.359 and 0.125 and 0.118, respectively). Conclusion Our study showed that complications occurred in only 4.8% of TA sessions. The most common complication was technical problems.