Y XIAO 1, K MUDIE 2, G KENNEDY 2, D RANGANATHAN 1
1Department of Nephrology, Royal Brisbane and Women’s Hospital, Herston, Australia, 2Department of Haematology, Royal Brisbane and Women’s Hospital, Herston, Australia
Aim: We report outcomes for therapeutic plasma exchange (TPE) in renal conditions in a tertiary care centre.
Background: Since 2007, American Society for Apheresis (ASFA) has been publishing guidelines on TPE. However, despite it being a widely adopted practice, there are no published Australian guidelines.
Methods: We searched our database of patients having TPE for renal indications from May 2014 to April 2018 and performed a retrospective audit on the outcomes according to disease specific criteria. A total of 25 patients were included, among which 16 had diagnosis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, 6 had anti-glomerular basement membrane (GBM) disease, 3 had recurrent focal segmental glomerulosclerosis (FSGS) in the allograft.
Results: The majority of patients with concurrent diffuse alveolar haemorrhage (DAH) responded to TPE. More proteinase 3 (PR3)-ANCA vasculitis patients (29%) had complete renal recovery than their myeloperoxidase (MPO)-ANCA vasculitis counterparts (17%). Despite 80% of anti-GBM patients having anti-GBM level dropping to undetectable level at 1 month, none of them achieved renal function recovery. The only treatment-resistant patient in the recurrent FSGS group had repeated transplant.
Conclusions: The outcomes of TPE in renal conditions in our centre are consistent with the current published data. We support the use of TPE for DAH. The utilisation of serial anti-GBM levels to monitor treatment outcomes is not useful as there is a discrepancy between anti-GBM level and disease presence/severity. Based on our data, MPO-ANCA vasculitis may have worse long-term outcome than PR3-ANCA vasculitis as patients were less likely to return to their baseline renal function. Likewise, repeated transplant patients with recurrent FSGS seemed to have increased risk of treatment failure. More research is needed to guide management.
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