ORIGINAL ARTICLE   

Minerva Pediatrica 2017 April;69(2):113-20

DOI: 10.23736/S0026-4946.16.04152-9

Copyright © 2014 EDIZIONI MINERVA MEDICA

lingua: Inglese

Plasma-exchange in pediatric patients: a single-center experience

Fabio PAGLIALONGA, Gianluigi ARDISSINO, Silvia CONSOLO, Luciana GHIO, Mirco BELINGHERI, Sara TESTA, Antonietta BIASUZZI, Alberto EDEFONTI ✉

Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

BACKGROUND: Plasma-exchange (PEX) has been well described in pediatrics, but most of the current indications are derived from adult experience. Aim of the study was to review the PEX treatments in our Unit over a six-year period.
METHODS: Three hundred and seventy-seven PEX sessions were performed in 38 patients (median age 12.1 years, range 0.6-20.5). Double-needle and single-needle PEX combined with hemodialysis and PEX combined with ultrafiltration were performed in 9, 1 and 3 patients respectively. The most common indications to PEX were atypical hemolytic uremic syndrome (aHUS, 9 patients), focal segmental glomerulosclerosis (FSGS, 9 cases), antibody mediated rejection (AMR) in renal transplant (rTx) recipients (8 patients) and hyperimmunization in patients waiting for rTx (4 cases).
RESULTS: We treated five patients with aHUS on native kidneys with PEX only, with complete remission in 4/6 recurrences; PEX was also successfully used to prevent HUS relapse in three patients undergoing rTx. Only one partial remission was obtained in four patients with FSGS on native kidneys, by means of treatment protocols based on PEX and immunosuppressants; conversely, a partial remission was observed in 6/6 patients with recurrence of FSGS on rTx. Immunosuppressive protocols combined with PEX proved useful in sensitized cadaveric rTx recipients (2/4 successfully transplanted), but failed in 6 patients with chronic AMR. As regards complications, two severe adverse reactions occurred: an anaphylactic shock after the use of albumin and an abdominal hemorrhage.
CONCLUSIONS: PEX is a relatively safe procedure in children. Pediatric patients with aHUS, recurrent FSGS and sensitized rTx recipients seem to benefit from treatment strategies including PEX.

KEY WORDS: Plasma exchange - Blood component removal - Atypical hemolytic uremic syndrome - Glomerulosclerosis, focal segmental - Immunization