Background: Therapeutic plasma exchange (TPE) is a crucial intervention in pediatric intensive care, offering vital treatment for a range of conditions. This study aims to document the experiences with TPE in a pediatric transplant care setting, acknowledging its advantages while also recognizing the potential risks and complications that may vary according to patient demographics and underlying medical conditions.
Materials and Methods: This observational study assessed 192 pediatric patients who received 780 TPE sessions at the Pediatric Intensive Care Unit (PICU) of Başkent University Hospital, Ankara, from December 2018 to December 2023. The efficacy of TPE was measured using several criteria: the normalization of renal function in nephrotic syndrome; the restoration of normal platelet counts and hemoglobin levels in hemolytic uremic syndrome; improved renal function and a reduction in donor-specific antibodies in chronic antibody-mediated rejection; and a decrease in transaminase levels and stabilization of liver function in liver transplant recipients experiencing acute rejection. Comprehensive data on patient demographics, clinical features, laboratory results, TPE indications, and documented complications were retrospectively gathered and analyzed using SPSS version 25.
Results: The patient group had a mean age of 11.01 ± 6.22 years, comprising 52.1% males and 47.9% females. The majority of TPE sessions (83.3%) utilized fresh frozen plasma, while albumin was employed in 16.7% of cases. The interventions predominantly addressed renal (43.06%) and liver (39.8%) conditions. Significant renal indications included atypical hemolytic uremic syndrome, focal segmental glomerulosclerosis, and pre- and post-renal transplantation scenarios. Liver-related treatments focused on acute liver failure, chronic liver failure, and deranged liver function post-transplantation. The primary complications encountered were mild hypotension (14.9%), severe hypotension (7.4%), fever (10.7%), allergic reactions (12.6%), and vascular access related issues (7.8%). Survival was observed in 81% of cases, 15% required additional interventions such as transplantations, and mortality was noted in 4% of the patient group.
Conclusion: TPE has been demonstrated to be a safe and life-saving procedure that effectively manages a wide array of clinical conditions, offering significant benefits, including the reversal of compromised kidney and liver functions. Despite some complications, with effective team coordination and robust management protocols, these issues can be effectively addressed. Vigilant monitoring and personalized care during TPE procedures in children are crucial, ensuring the maximization of TPE's therapeutic potential while minimizing risks.