Recent advances in therapeutic apheresis.
Recent advances in therapeutic apheresis include technical improvements, new indications, and pathophysiological insights. A new device that adsorbs endotoxins onto immobilized human albumin from human whole blood was recently developed. In a prospective randomized controlled trial (endotoxin adsorber study EASY), apheresis-treated patients had more improved APACHE II scores than controls. In a prospective randomized trial, the Prosorba column containing immobilized staphylococcal protein A was tested against sham apheresis in patients with end-stage rheumatoid arthritis. A significant improvement occurred in 42% of the treated patients vs. 16% of the controls. Sudden hearing loss was treated in a prospective randomized trial by a single heparin-induced extracorporeal LDL precipitation (HELP) treatment in comparison with conservative therapy. In patients with elevated fibrinogen and/or low-density lipoprotein (LDL) cholesterol levels, HELP was significantly superior to 10 days of intravenous conventional treatment. Promising results were achieved in prospective randomized trials applying immunoadsorption in end-stage dilated cardiomyopathy and rheopheresis in age-related macular degeneration. In a noncontrolled trial, C4d-positive acute humoral rejection after kidney transplantation could be effectively treated by immunoadsorption. Finally, HELP apheresis was simplified by using new hardware (HELP-Futura). Direct adsorption of lipids (DALI)-LDL-apheresis was improved by testing DALI 1250 adsorbers with improved capacity. High-blood-flow DALI was shown to be safe and effective, with the advantage of reduced treatment time. Last but not least, a modification of dextran-sulfate cellulose LDL apheresis was developed for direct LDL hemoperfusion.
Nephrology Division, Department I of Internal Medicine, University Hospital Munich-Grosshadern, D-81377 Munich, Germany. Bosch@med1.med.uni-muenchen.de
Thomas
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Bosch
D001172:Arthritis, Rheumatoid / Q000628:therapy; D001781:Blood Component Removal / Q000295:instrumentation / Q000379:methods* / Q000639:trends*; D002311:Cardiomyopathy, Dilated / Q000628:therapy; D002986:Clinical Trials as Topic; D006084:Graft Rejection / Q000628:therapy; D034381:Hearing Loss / Q000628:therapy; D006801:Humans; D006949:Hyperlipidemias / Q000628:therapy; D016030:Kidney Transplantation; D008268:Macular Degeneration / Q000628:therapy; D018805:Sepsis / Q000628:therapy