Journal of Clinical Apheresis最新文献

This study aimed to assess the safety and therapeutic efficacy of increasing the dosage of the double plasma molecular adsorption system (DPMAS) in patients with liver failure during regional citrate anticoagulation (RCA). A prospective nonrandomized controlled trial was conducted. Three groups (3 L group, 4.5 L group, and 6 L group) of patients with liver failure receiving DPMAS treatment were created on the basis of various therapeutic plasma volumes. A total of 303 patients were included, with 110 in the 3 L group, 121 in the 4.5 L group, and 72 in the 6 L group. At the end of treatment, there was a statistically significant difference in the bilirubin clearance rate among the groups (H = 15.239, p < 0.001). Pairwise comparisons revealed that only the difference in the bilirubin clearance rates between the 6 L group and the 3 L group was statistically significant (p < 0.001). With the exception of base excess, no statistically significant differences were found between these three groups for any of the relevant laboratory indicators (p > 0.05). The incidence of hypotension, hypocalcemia, acidosis, alkalosis, hypernatremia, hyperlactatemia, and allergic reactions did not differ significantly among these three groups (p > 0.05). Furthermore, a statistically significant difference was found in clotting events among these three groups (p = 0.027), with a higher incidence observed in the 6 L group than in the 3 L group (p = 0.011). Increasing the therapeutic dose of RCA-DPMAS further removed bilirubin and did not increase the complications associated with citrate anticoagulation, but the coagulation risk is a concern.

The demand for double-filtration plasmapheresis (DFPP) in clinical settings is growing steadily, yet the range and availability of specialized equipment designed to support DFPP are relatively limited. We aimed to assess the efficacy and safety of a designed auxiliary line for DFPP treatment using standard continuous renal replacement treatment (CRRT) machines. This prospective self-controlled study was conducted between May 2021 and April 2024. Patients who underwent DFPP treatment using both specialized DFPP machines and standard CRRT machines (using designed auxiliary line) were enrolled in the study. DFPP sessions were divided into the specialized DFPP machine group and the standard CRRT machine group. The rates of completed DFPP treatments, DFPP cost, circuit clotting, hypotension, anaphylaxis, hypocalcemia, and nurse operating time were compared. A total of 440 DFPP sessions were performed for 80 patients, with 330 (75.0%) sessions in the specialized DFPP machine group and 110 (25.0%) in the standard CRRT machine group. There were no statistically significant differences between the two groups in terms of the completed DFPP treatment rate (89.4% vs. 88.2%, p = 0.724), circuit clotting (8.2% vs. 7.3%, p = 0.760), anaphylaxis (12.7% vs. 11.8%, p = 0.803), hypotension (10.6% vs. 9.1%, p = 0.650), hypocalcemia (17.3% vs. 20.0%, p = 0.519), and nurse operation time (35.08 ± 2.27 min vs. 36.62 ± 1.94 min, p = 0.082). However, the cost per DFPP session in the standard CRRT machine group was lower than in the specialized DFPP machine (976.81 ± 14.38 $ vs. 1007.43 ± 35.30 $, p < 0.001). Standard CRRT machines can effectively and safely perform DFPP treatment using a specially designed auxiliary line, which is more cost-effective. Even in primary hospitals without specialized DFPP machines, CRRT machines can be used to perform DFPP treatment.

The question of standardizing the measurement of lipoprotein(a) [Lp(a)] has been discussed for many years, but the unavailability of automated methods insensitive to the structural heterogeneity of Lp(a) and the transition to a new unit of measurement have delayed this process. The aim of this study is to compare, in subjects undergoing regular lipoprotein apheresis (LA) treatment (31 subjects, mean age 62 ± 11 years, female 7/31), Lp(a) measurements performed using routine polyclonal antibodies with a method that recognizes a single copy of apo(a) per molecule. This pilot study for adopting an assay insensitive to apo(a) size polymorphism showed a good match with the traditional method: correlations between pre-LA and post-LA measures show an R² of 0.89 and 0.76, respectively. Despite the interpretative problem caused by adopting different units of measurement, we believe that moving to an assay insensitive to the dimensional variation of apo(a) represents a necessary change to standardize, improve, and extend the accuracy and diagnostic power of Lp(a).

Prior studies examining therapeutic plasma exchange (TPE)-containing regimens in pulmonary transplant antibody-mediated rejection (AMR) have been limited by sample size and inconsistent application of TPE. In this single-center, retrospective study, patients with pulmonary transplant AMR who received a TPE-containing treatment regimen were examined. Mean fluorescence intensity (MFI) and Class distribution of DSAs were examined before/after 5 TPE and again after 8 TPE in the subset of patients who received an extended course of TPE. Fifty-two patients who completed 5 TPE were included. Testing of serum at 1:1 and 1:16 prior to initiation of TPE demonstrated that Class II DSAs occurred more frequently and at a higher MFI compared to Class I DSAs. After completing 5 TPE, for both 1:1 and 1:16 testing, the MFI of DSAs decreased significantly regardless of Class. For 4 patients with persistent DSAs, extending the course of TPE to 8 procedures did not cause an additional significant decline in the MFI of DSAs. Four patients developed de novo DSAs during the course of 5 TPE. Development of de novo DSAs was not associated with plasma exposure during TPE and was associated with high morbidity. In conclusion, completion of 5 TPE during treatment for pulmonary transplant AMR is associated with significant declines in DSAs regardless of HLA Class. Extending the course of TPE for DSAs which persist despite 5 TPE may be of limited benefit. De novo development of DSAs during the course of 5 TPE is associated with poor outcomes.

Myasthenia gravis (MG) is an autoimmune disorder caused by autoantibodies against proteins of the neuromuscular junction, such as the acetylcholine receptor (AChR). While therapeutic plasma exchange (TPE) has been a standard chronic therapy for patients with poorly controlled MG, new medications have recently been approved by the FDA for such patients. We report the impact of a new therapy, efgartigimod, on the number of therapeutic plasma exchanges performed on patients with generalized MG in our apheresis unit. A retrospective chart review was performed for patients with MG between 2018–2019 (pre-efgartigimod) and 2022–2023 (post-efgartigimod). We evaluated any changes between the two periods, including the total number of MG patients, the proportion of TPEs that were performed for MG, and the proportion of inpatient TPEs for MG. A statistically significant reduction (p < 0.0001) was observed in the proportion of total TPE procedures for MG between the two time periods. In AChR-antibody positive (AChR-Ab +) patients who received both inpatient and outpatient procedures, there was a significant increase in the proportion of inpatient procedures post-efgartigimod (p = 0.0035). Our study demonstrated a decrease in the overall use of chronic TPE for MG over the 2-year period following the release of efgartigimod. However, there will remain a role for TPE in the setting of acute MG flares, the inpatient setting, during pregnancy, and in those who do not tolerate the new medications.

Although therapeutic plasma exchange (TPE) can be associated with bleeding, there are currently no known strategies to reliably predict bleeding risk. This study developed a TPE bleeding risk prediction model for hospitalized patients. To develop the prediction model, we undertook a secondary analysis of public use files from the Recipient Epidemiology and Donor Evaluation Study-III. First, we used a literature review to identify potential predictors. Second, we used Multiple Imputation by Chained Equations to impute variables with < 30% missing data. Third, we performed a 10-fold Cross-Validated Least Absolute Shrinkage and Selection Operator to optimize variable selection. Finally, we fitted a logistic regression model. The model identified 10 unique predictors and seven interactions. Among those with the highest odds ratios (OR) were the following: > 10 TPE procedures and antiplatelet agents (OR 3.26); nephrogenic systemic sclerosis (OR 3.15); and intensive care unit stay (OR 3.08). Among those with the lowest OR were the following: albumin-only TPE (OR 0.50); male sex (OR 0.82); and heart failure (OR 0.85). The model indicated an acceptable performance with a C-statistic of 0.71 (95% CI 0.699–0.717). A model to predict bleeding risk among hospitalized patients undergoing TPE identified key predictors and interactions. Although the model achieved acceptable performance, future studies are needed to validate and operationalize it.