Introduction: Blood purification techniques like Therapeutic Plasma Exchange (TPE) are expensive and have limitations in resource-constrained settings. This study compared mDFPP, a more accessible technique, to TPE for its safety, effectiveness, and cost.
Conventional Double Filtration Plasmapheresis (DFPP) requires specialized filters, limiting its use. mDFPP utilizes a readily available, large-pore dialyzer as a second filter, making it more feasible. Both methods aim to remove large unwanted molecules from the blood. Past research (since 2003) supports mDFPP's effectiveness in pre-transplant desensitization.
Methods: We analyzed data from four centers that used mDFPP and TPE on 78 patients (28 TPE, 50 mDFPP). The groups had similar demographics (age, gender). Pre-transplant applications were more common than non-transplant uses.
The mDFPP procedure involves connecting a plasma filter to a large dialyzer, reducing the need for expensive sets. Blood and filtrate flow rates are precisely controlled, and treated plasma is returned to the patient. The goal was an 80% reduction in pre-treatment IgG levels.
Results: Showed mDFPP to be safe and effective. IgG reduction exceeded 60% in most patients, with the mDFPP group requiring fewer treatment cycles compared to TPE. Notably, mDFPP had a significantly lower complication rate (58 episodes) than TPE (124 episodes).
Most importantly, achieving the therapeutic target was significantly cheaper with mDFPP, costing over 50% less than TPE. Commonly used replacement fluids were albumin and saline.
Conclusion: This study suggests that mDFPP is a safe, cost-effective alternative to TPE in low-resource settings. It offers comparable therapeutic benefits with a simpler and less expensive approach.