Risk Factors for Adverse Events of Therapeutic Plasma Exchange Assessed in a Single Center Study

Abstract

Background: Therapeutic plasma exchange (TPE) is used to remove pathologic substances involved in various disease etiologies. The use of TPE is increasing steadily in a variety of disease. This study analyzed the incidence, type and severity of adverse events (AE) according to the initial TPE of each patient in a single center. The risk factors for AE of TPE were also elucidated. Methods: The medical and laboratory records of patients, who received TPE from January 2014 to December 2018, were reviewed retrospectively. The signs or symptoms during and after TPE were analyzed. Results: TPE sessions were performed on 95 patients. The mean age was 53.3 years and men comprised 63.2%. The most common indication for TPE was desensitization for ABO-incompatible liver transplantation (ABO-i LT) (N=56, 58.9%). A total of 27 patients (28.4%) experienced AE during the initial TPE. The types of AE were allergic reactions (N=14, 14.7%), anaphylactic reaction (N=3, 11.1%), hypotension (N=5, 5.3%), hypocalcemic reaction (N=4, 4.2%), and febrile nonhemolytic reaction (N=1, 1.1%). The severities of AE were evaluated as mild in eight procedures (8.4 %), moderate in seventeen (17.9 %), and severe in two (2.1 %). Multivariable logistic regression analysis showed that the desensitization for ABO-i LT (odds ratio (OR), 2.08; 95% CI, 1.03∼4.22) and the amount of FFP (OR, 1.07; 95% CI, 1.01∼1.09) were associated with a higher incidence of AE. Conclusion: TPE can be performed under careful patient monitoring to provide prompt intervention, particularly in patients with desensitization of ABO-i LT using FFP. (Korean J Blood Transfus 2019;30:148-155)