title: Decreasing frequency of plasma exchange complications in patients treated for thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, 1996 to 2011.
abstract: BACKGROUND
  Plasma exchange (PEX) treatment for patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) has risk for major complications.
  
  
  METHODS
  Data for PEX-related complications have been prospectively collected on all patients enrolled in the Oklahoma TTP-HUS Registry, 1996 to 2011. PEX-related complications have been defined as major or minor and as central venous catheter related or plasma related.
  
  
  RESULTS
  During 15 years, 1996 to 2011, 72 (24%) of 302 consecutive patients had major PEX-related complications. Analysis of five consecutive 3-year cohorts demonstrated that there has been a significant trend for decreasing frequency of all PEX-related major complications (p = 0.014) and central venous catheter-related major complications (p = 0.021) but not for the less common plasma-related major complications (p = 0.380). ADAMTS13 activity was measured in 288 (95%) of the 302 patients. Analysis of the 66 patients with ADAMTS13 activity of less than 10% demonstrated a significant trend for decreasing frequency of PEX-related major complications (p = 0.036); the trend for the 222 patients with ADAMTS13 activity of at least 10% was not significant (p = 0.118). The decreased frequency of PEX-related major complications among patients with ADAMTS13 activity of less than 10% may be related to a significant trend for decreasing duration of PEX treatment (p = 0.040) and decreasing frequency of requirement for more than one central venous catheter (p = 0.044). The decreased duration of PEX treatment may be related to increased use of adjunctive treatments: corticosteroids (p < 0.001) and rituximab (p < 0.001).
  
  
  CONCLUSIONS
  The frequency of PEX-related major complications has decreased from 1996 to 2011, possibly related to increased use of corticosteroids and rituximab and the decreased duration of PEX required to achieve remission.
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, Department of Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, USA.
authors.forename: Sumit
authors.initials: S
authors.lastname: Som
authors.forename: Cassandra C
authors.initials: CC
authors.lastname: Deford
authors.forename: Mandi L
authors.initials: ML
authors.lastname: Kaiser
authors.forename: Deirdra R
authors.initials: DR
authors.lastname: Terrell
authors.forename: Johanna A
authors.initials: JA
authors.lastname: Kremer Hovinga
authors.forename: Bernhard
authors.initials: B
authors.lastname: Lämmle
authors.forename: James N
authors.initials: JN
authors.lastname: George
authors.forename: Sara K
authors.initials: SK
authors.lastname: Vesely
mesh_terms: D051722:ADAM Proteins / Q000378:metabolism; D000071120:ADAMTS13 Protein; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects; D004502:Education, Medical, Continuing; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D009017:Morbidity; D009825:Oklahoma / Q000453:epidemiology; D010951:Plasma Exchange / Q000009:adverse effects* / Q000401:mortality*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D012042:Registries / Q000706:statistics & numerical data; D012074:Remission Induction; D012307:Risk Factors; D000069283:Rituximab; D018805:Sepsis / Q000401:mortality
chemical_list: D000305:Adrenal Cortex Hormones; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human