title: Membrane versus centrifuge-based therapeutic plasma exchange: a randomized prospective crossover study.
abstract: BACKGROUND
  Therapeutic plasma exchange (TPE) is either performed using a highly permeable filter with standard multifunctional renal replacement equipment (mTPE) or a centrifugation device (cTPE). Although both techniques are well established in clinical practice, performance of these two modes of TPE was never compared in a prospective randomized fashion. Thus we aimed to compare two commercially available therapeutic apheresis systems: mTPE (Octonova with Plasmaflo filter) and cTPE (Spectra Optia apheresis system).
  
  
  METHODS
  Twenty-one patients (age 51.6 ± 13.5 years; 10 F/11 M; BMI 25.1 ± 5.0 kg/m(2)) were enrolled in this randomized, prospective, paired, crossover study performed in the Hannover Medical School, Germany. First treatment (either mTPE or cTPE) was chosen by an online randomization list. The primary endpoints were plasma removal efficiency with 1.2× of the total plasma volume exchanged. Secondary endpoints were total amount of plasma substances removed, such as IgG and fibrinogen. Further, the treatment effect on platelet count and complications were evaluated.
  
  
  RESULTS
  Despite a comparable volume of the processed plasma, mTPE treatment time was 10.5 % longer than cTPE treatment time (p < 0.05), resulting in a 10 % lower plasma removal rate of the mTPE treatment. Both treatments were comparable in terms of decrease in median (IQR) IgG [pre-mTPE 5.34 (3.48-8.37), post-mTPE 1.96 (1.43-2.84) g/L; pre-cTPE 5.88 (3.42-8.84), post-cTPE 1.89 (1.21-3.52) g/L]. Also the median (IQR) amount of IgG removed in mTPE [13.14 (7.42-16.10) g] was not different from the cTPE treatment [9.30 (6.26-15.69) g]. This was also true for IgM removal. Platelet loss during mTPE was nearly twice as much as with cTPE (15 ± 9 versus 7 ± 9 %, p < 0.05).
  
  
  CONCLUSIONS
  Although the centrifugal procedures were conducted using flow rates that could easily be obtained using peripheral access, plasma removal efficiency was significantly higher and treatment time was significantly lower in cTPE as compared to mTPE. Despite this lower treatment time, the decline in markers of procedure efficacy was comparable. Especially in centers performing many procedures per year, cTPE in contrast to mTPE can reduce treatment time without compromising treatment efficacy.
authors.affiliation: Department of Nephrology and Hypertension, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Hafer
authors.affiliation: Department of Nephrology and Hypertension, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Paulina
authors.initials: P
authors.lastname: Golla
authors.affiliation: Terumo BCT, Zaventem, Belgium.
authors.forename: Marion
authors.initials: M
authors.lastname: Gericke
authors.affiliation: Department of Nephrology and Hypertension, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.|Medical Clinic V, Teaching Hospital Braunschweig, Braunschweig, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Eden
authors.affiliation: Department of Haematology, Oncology and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany.
authors.forename: Gernot
authors.initials: G
authors.lastname: Beutel
authors.affiliation: Department of Nephrology and Hypertension, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Julius J
authors.initials: JJ
authors.lastname: Schmidt
authors.affiliation: Department of Nephrology and Hypertension, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Bernhard M W
authors.initials: BM
authors.lastname: Schmidt
authors.affiliation: Terumo BCT, Zaventem, Belgium.
authors.forename: Stef
authors.initials: S
authors.lastname: De Reys
authors.affiliation: Department of Nephrology and Hypertension, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. Kielstein@yahoo.com.|Medical Clinic V, Teaching Hospital Braunschweig, Braunschweig, Germany. Kielstein@yahoo.com.
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
mesh_terms: D002498:Centrifugation; D018592:Cross-Over Studies; D005260:Female; D005858:Germany; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010951:Plasma Exchange / Q000295:instrumentation*; D010953:Plasma Volume; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D008567:Membranes, Artificial
keywords: Antibodies; Apheresis; Extracorporeal treatment; IgG