title: Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units.
abstract: BACKGROUND
  Few observations on apheresis in pediatric nephrology units have been published.
  
  
  METHODS
  This retrospective study involved children ≤18 years undergoing plasma exchange (PE), immunoadsorption (IA), or double filtration plasmapheresis (DFPP) in 12 European pediatric nephrology units during 2012.
  
  
  RESULTS
  Sixty-seven children underwent PE, ten IA, and three DFPP, for a total of 738 PE and 349 IA/DFPP sessions; 67.2 % of PE and 69.2 % of IA/DFPP patients were treated for renal diseases, in particular focal segmental glomerulosclerosis (FSGS), hemolytic-uremic syndrome (HUS), and human leukocyte antigen (HLA) desensitization prior to renal transplantation; 20.9 % of PE and 23.1 % of IA/DFPP patients had neurological diseases. Membrane filtration was the most common technique, albumin the most frequently used substitution fluid, and heparin the preferred anticoagulant. PE achieved full disease remission in 25 patients (37.3 %), partial remission in 22 (32.8 %), and had no effect in 20 (29.9 %). The response to IA/DFPP was complete in seven patients (53.8 %), partial in five (38.5 %), and absent in one (7.7 %). Minor adverse events occurred during 6.9 % of PE and 9.7 % of IA/DFPP sessions.
  
  
  CONCLUSIONS
  PE, IA, and DFPP are safe apheresis methods in children. Efficacy is high in pediatric patients with recurrent focal segmental glomerulosclerosis (FSGS), atypical hemolytic uremic syndrome (HUS), human leukocyte antigen (HLA) sensitization, and neurological autoimmune diseases.
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 9, 20122, Milan, Italy, fabiopaglialonga@alice.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Paglialonga
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Schmitt
authors.forename: Rukshana
authors.initials: R
authors.lastname: Shroff
authors.forename: Karel
authors.initials: K
authors.lastname: Vondrak
authors.forename: Christoph
authors.initials: C
authors.lastname: Aufricht
authors.forename: Alan Rees
authors.initials: AR
authors.lastname: Watson
authors.forename: Gema
authors.initials: G
authors.lastname: Ariceta
authors.forename: Michael
authors.initials: M
authors.lastname: Fischbach
authors.forename: Gunter
authors.initials: G
authors.lastname: Klaus
authors.forename: Tuula
authors.initials: T
authors.lastname: Holtta
authors.forename: Sevcan A
authors.initials: SA
authors.lastname: Bakkaloglu
authors.forename: Alexandra
authors.initials: A
authors.lastname: Zurowska
authors.forename: Augustina
authors.initials: A
authors.lastname: Jankauskiene
authors.forename: Johan
authors.initials: J
authors.lastname: Vande Walle
authors.forename: Betti
authors.initials: B
authors.lastname: Schaefer
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wright
authors.forename: Roy
authors.initials: R
authors.lastname: Connell
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
mesh_terms: D000293:Adolescent; D001781:Blood Component Removal / Q000379:methods* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000628:therapy*; D008297:Male; D009398:Nephrology / Q000379:methods; D010372:Pediatrics / Q000379:methods; D012189:Retrospective Studies