Zhang Yu, Xie Qing, Chen Yaxian, Yang Juanjuan, Huang Shi, Deng Linxia, Zhou Jianhua
Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Transl Pediatr. 2023 Mar 31;12(3):354-363. doi: 10.21037/tp-22-322. Epub 2023 Mar 15.
Double filtration plasmapheresis (DFPP) was initially used to facilitate the conduction of ABO-incompatible renal transplantation. The applicability of DFPP has recently expanded to cover the removal of various antibodies in adults with immune-mediated diseases. However, DFPP is seldom used in children, with few reports addressing its efficacy and safety in this population. This study aimed to explore the efficacy and adverse effects of DFPP for pediatric patients with renal indications.
Children who received DFPP between December 2017 and December 2020 at Tongji Hospital were retrospectively studied, and sub-grouped for analysis according to the types of disease. All children received 3 to 6 DFPP sessions within 2 to 3 weeks, and were assessed for clinical outcomes according to glomerular filtration rate, proteinuria and extra-renal symptoms. Pre- and post-DFPP plasma were collected to measure the levels of pathogenic autoantibodies, immunoglobulins, fibrinogen, albumin, calcium, etc. In-hospital complications were also recorded.
Totally there were 10 children receiving 44 sessions of DFPP, including 2 males and 8 females, with a median age of 11.2 years old (5-13 years) and a median weight of 42.1 kg (20-59 kg). Five patients were treated for systemic lupus erythematosus (SLE), three patients for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), one for C3 glomerulopathy and one for ABO-incompatible renal transplantation. Plasma autoantibodies decreased substantially by 93% and 89% in those with SLE and AAV after the last session, respectively. Complete or partial responses were achieved in 80%, 33.3%, 100% and 100% of patients with SLE, AAV, C3 glomerulopathy, and ABO-incompatible renal transplantation, respectively. The proportion of cumulative IgG, fibrinogen, and albumin removal at the end of the last sessions were 58.8%, 67.69%, and 14.05% respectively. The removal of calcium, potassium and creatinine were not statistically significant. A few episodes (4.55%) of hypotension were observed when fresh frozen plasma was used as the replacement fluid, and no bleeding nor severe anaphylaxis was noted.
The efficacy and safety of DFPP treatment in children with SLE, AAV, C3 glomerulopathy and ABO-incompatible renal transplantation were described in the present study. DFPP is proven to be a safe apheresis method for children weighing more than 20 kg.
双重滤过血浆置换术（DFPP）最初用于促进ABO血型不相容肾移植的进行。最近，DFPP的适用范围已扩大到清除患有免疫介导疾病的成人中的各种抗体。然而，DFPP在儿童中很少使用，关于其在该人群中的疗效和安全性的报道很少。本研究旨在探讨DFPP对有肾脏适应证的儿科患者的疗效和不良反应。
对2017年12月至2020年12月在同济医院接受DFPP治疗的儿童进行回顾性研究，并根据疾病类型进行亚组分析。所有儿童在2至3周内接受3至6次DFPP治疗，并根据肾小球滤过率、蛋白尿和肾外症状评估临床结局。采集DFPP治疗前后的血浆，检测致病性自身抗体、免疫球蛋白、纤维蛋白原、白蛋白、钙等水平。还记录了住院期间的并发症。
共有10名儿童接受了44次DFPP治疗，其中男性2名，女性8名，中位年龄为11.2岁（5 - 13岁），中位体重为42.1 kg（20 - 59 kg）。5例患者因系统性红斑狼疮（SLE）接受治疗，3例因抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）接受治疗，1例因C3肾小球病接受治疗，1例因ABO血型不相容肾移植接受治疗。最后一次治疗后，SLE和AAV患者的血浆自身抗体分别大幅下降了93%和89%。SLE、AAV、C3肾小球病和ABO血型不相容肾移植患者的完全或部分缓解率分别为80%、33.3%、100%和100%。最后一次治疗结束时，累积IgG、纤维蛋白原和白蛋白的清除比例分别为58.8%、67.69%和14.05%。钙、钾和肌酐的清除无统计学意义。当使用新鲜冷冻血浆作为置换液时，观察到少数几例（4.55%）低血压事件，未发现出血或严重过敏反应。
本研究描述了DFPP治疗儿童SLE、AAV、C3肾小球病和ABO血型不相容肾移植的疗效和安全性。DFPP被证明是一种对体重超过20 kg儿童安全的血液分离方法。
