RÉSUMÉ
【Objective】 To investigate the clinical efficacy of preoperative therapeutic plasma exchange(TPE) in preventing acute rejection after ABO incompatible kidney transplantation(ABOi-KT). 【Methods】 Nine patients with ABOi-KT who were admitted to the renal transplant department of our hospital from April 2022 to April 2024 were retrospectively analyzed. They received a total of 28 TPEs before kidney transplantation, and the treatment plan was summarized as follows: The proportion of the substitute fluid, as well as the frequency and volume of TPE were determined based on the patient′s ABO blood group system antibody titer, gender, height, weight, hematocrit and other indicators upon admission. The patient′s relevant laboratory indicators, including hemoglobin, platelets, leukocytes, coagulation function, total protein, albumin, globulin, A/G, creatinine and urea nitrogen upon admission and after TPE were monitored and statistically analyzed. After transplantation, changes in renal function indicators such as ABO blood group system antibody titers, creatinine and urinary excretion were observed, and clinical symptoms of acute rejection, such as swelling, pain and edema in the transplanted kidney area were observed. 【Results】 Nine ABOi-KT patients had an average of about 3 TPEs before transplantation surgery, with an average total volume of approximately 2 500 mL to 3 500 mL per TPE, or approximately about 1.01 to 1.16 plasma volume (PV). After multiple TPEs, pre-transplantation antibody titers decreased by an average of 3 times compared to before TPE. There were no statistically significant differences in Hb, PLT, PT, PTA, INR, TBil, ALB, Cr and BUN (P>0.05), while statistically significant differences were found in WBC, APTT, Fbg, TP, GLB and A/G (P<0.05). After surgery, the creatinine level of 9 patients dropped to approximately 100 to 140 μmol/L, the urine output was normal, and the urine protein dropped to weakly positive or negative values. None of the nine patients experienced acute rejection. 【Conclusion】 TPE can effectively reduce the level of ABO blood group antibody and prevent the occurrence of acute rejection in ABOi-KT patients.
RÉSUMÉ
【Objective】 To compare the efficacy of double filtration plasmapheresis(DFPP), centrifugal therapeutic plasma exchange(cTPE) and centrifugation-filtration plasmapheresis(CFPP) in improving renal insufficiency after kidney transplantation, as well as the differences in inducing plasma exchange-related adverse reactions. 【Methods】 Clinical data from 46 patients who underwent plasma exchange after renal transplantation in our hospital were retrospectively collected, and patiens were divided into DFPP group(n=33), cTPE group(n=7) and CFPP group(n=6). Changes in peripheral blood creatinine, albumin, hemoglobin, platelets, fibrinogen levels and urine volume before and after TPE were compared and analyzed among the three groups. 【Results】 Among the DFPP group, cTPE group and CFPP group, the creatinine after TPE decreased by (31.40±25.38)%, (58.91±19.75)% and (39.44±28.64)%, respectively, with cTPE group significantly higher than the DFPP group(P0.05); the urine volume after TPE increased by (49.33±30.03)%, (54.62±39.32)% and (68.89±23.00)%, showing no significant differences(P>0.05); the hemoglobin after TPE decreased by (11.97±5.94)%, (20.17±5.75)% and (9.65±8.75)%, respectively, with the cTPE group significantly higher than the DFPP group and CFPP group(P0.05). The platelet count after TPE decreased by (37.88±18.39)%, (24.56±12.36)% and (21.40±12.51)%, respectively, with no significant differences between the three groups(P>0.05); the fibrinogen after TPE decreased by (0.57±0.20)%, (0.14±0.06)% and (0.26±0.22)%, respectively, with the DFPP group significantly higher than the cTPE group(P0.05); the albumin after TPE decreased by (11.41±5.97)%, (14.67±6.52)% and (25.18±5.10)%, respectively, with cTPE group and DFPP group significantly lower than the CFPP group(P0.05). 【Conclusion】 The effect of three plasma exchange methods varies on renal function, anemia and coagulation function of patients after kidney transplantation. It is necessary to consider the the patient’s disease characteristics and treatment needs, as well as the laboratory′s technical conditions and plasma supply when selecting TPE methods.
RÉSUMÉ
【Objective】 To review the occurrence of allergic reactions during therapeutic plasma exchange (TPE) and to explore the risk factors of TPE allergic reactions. 【Methods】 The clinical data of 929 patients treated with TPE using plasma components by the Department of Transfusion Medicine in our medical center from 2018 to 2023 were collected. The influencing factors of allergic reactions were analyzed by univariate analysis, and the independent risk factors of allergic reactions were analyzed by logistic multivariate regression analysis. 【Results】 A total of 4 071 TPEs were performed in 929 patients.Among them, 198 patients (21.31%) experienced 349 times (8.57%) of allergic reactions, with the incidence of grade Ⅰ, Ⅱ and Ⅲ allergic reactions of 16.33%, 81.38% and 2.29%, respectively, and no deaths. The univariate analysis showed that the patient′s age, allergy history, diagnosis of immune-related diseases, ICU admission, plasma consumption, total blood volume, maximum blood flow rate and combined use of albumin were related to the occurrence of allergic reactions (P<0.05). Multivariate regression analysis showed that young patients, a history of allergy, immune-related diseases and non-ICU patients were prone to allergic reactions in TPE, but the treatment options of TPE such as substitute fluid category, plasma consumption and blood flow rate were not related to the occurrence of allergic reactions. 【Conclusion】 There are significant individual differences in the occurrence of allergic reactions for TPE, and young age, history of allergies, immune-related diseases and non-ICU patients are risk factors for allergic reactions in TPE. Identifying patients with risk factors before TPE treatment and giving corresponding preventive measures can reduce the incidence of allergic reactions.
RÉSUMÉ
Background: Therapeutic plasma exchange (TPE) is the separation and removal of plasma from whole blood with replacement by a crystalloid/colloid solution (typically albumin or plasma). The DGHS has established guidelines and recommendations for application of therapeutic apheresis in clinical practice. Guillain-Barré syndrome (GBS) is considered category I indications for TPE. This study was undertaken to establish the effectiveness and safety of therapeutic plasma exchange in GBS which is one of the common indication for TPE at our tertiary care teaching hospital.Methods: A retrospective study of 30 patients admitted to a tertiary care teaching hospital, from January 2014 to December 2016 with clinical signs of Guillain-Barre syndrome (GBS) and/or GBS variants were evaluated for performing TPE. A total of 104 procedures were performed for 30 patients. Replacement of crystalloids and plasma was used. Medical Research Council scale was used to assess the clinical improvement by measuring the grade of muscle power. Information was collected in a structured proforma and statistical analysis was performed using SPSS software (version 20). P value less than 0.05 was considered statistically significant.Results: During the study period, 104 procedures were performed on 30 patients on an average of three procedures per patient. The average age of the patients was 41.4±10.4 years. The mean period of illness at admission was 14.5±5.4 (range 4-32) days. In 23 out of 30 patients, more than three TPE procedures were done, out of which 21 patients clinically improved. The common complications during the procedure were chills (16%), hypotension (10%) and non-hemolytic febrile transfusion reaction (10%) and they were managed accordingly. Two (6.7%) patients who were not ambulatory at discharge had significantly (p <0.05) lower grade of power in lower limbs at admission and all patients recovered fully on follow up.Conclusions: GBS is one of the most commonly occurring clinical paralytic disorders. 76.7% of patients underwent three or more cycles of TPE with 70% had excellent clinical improvement which was comparable with various other studies. Based on results published by various other studies, therapeutic plasma exchange is a comparatively safe and effective procedure