title: A randomized crossover study comparing membrane and centrifugal therapeutic plasma exchange procedures.
abstract: Therapeutic plasma exchange (TPE) can be performed either on a membrane-based system (mTPE) or on a device that separates blood components by centrifugation (cTPE). The number of studies in this field is limited. This randomized study is the first that offers data on the membrane-based Diapact device (B. Braun Medical, Inc.) for TPE procedures and compares it to the centrifuge-based Spectra Optia (Terumo BCT, Inc.).
  
  
  
  Twenty-seven patients were enrolled in this randomized prospective head-to-head study comparing the mTPE and cTPE systems. Procedures on both devices were standardized and the plasma removal efficiency (PRE); total procedure time (including setup and priming time); and removal efficiencies of blood cells, immunoglobulin (Ig)G, and fibrinogen for all procedures were analyzed.
  
  
  
  While both systems removed similar amounts of plasma, it took the cTPE device a mean of 101.5 ± 24.6 minutes to finalize a procedure that was one-third less than procedures on the mTPE device (157 ± 26.2 min; p < 0.0001), due to a difference in PRE between the Spectra Optia (83.0% ± 4.9%) and the Diapact (53.2% ± 6.6%; p < 0.0001). The difference in removal efficiencies of IgG and blood cells were not significantly different but the Spectra Optia was more efficient in removing the larger fibrinogen protein than the Diapact (72.3% ± 8.5% vs. 62.9% ± 16.1%, respectively; p < 0.02).
  
  
  
  This study shows that, although both systems perform adequate and safe TPE procedures, those on the Spectra Optia in comparison to the Diapact are more efficient in terms of plasma removal and significantly shorter.
authors.affiliation: Department of Nephrology, Arterial Hypertension, Dialysis and Kidney Transplantation, University Hospital Centre Zagreb, and Faculty of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Petar
authors.initials: P
authors.lastname: Kes
authors.affiliation: Terumo BCT Europe NV, Zaventem, Belgium.
authors.forename: Michiel Etienne
authors.initials: ME
authors.lastname: Janssens
authors.affiliation: Department of Nephrology, Arterial Hypertension, Dialysis and Kidney Transplantation, University Hospital Centre Zagreb, and Faculty of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Nikolina
authors.initials: N
authors.lastname: Bašić-Jukić
authors.affiliation: Department of Nephrology, Arterial Hypertension, Dialysis and Kidney Transplantation, University Hospital Centre Zagreb, and Faculty of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Milića
authors.initials: M
authors.lastname: Kljak
mesh_terms: D001773:Blood Cells; D002498:Centrifugation / Q000295:instrumentation / Q000379:methods; D018592:Cross-Over Studies; D005340:Fibrinogen / Q000302:isolation & purification; D006801:Humans; D007074:Immunoglobulin G / Q000302:isolation & purification; D008567:Membranes, Artificial; D010951:Plasma Exchange / Q000379:methods* / Q000592:standards; D013997:Time Factors
chemical_list: D007074:Immunoglobulin G; D008567:Membranes, Artificial; D005340:Fibrinogen