(1438) Comparing Outcomes of Centrifugal Versus Membrane Therapeutic Plasma Exchange in Pediatrics

Introduction: Therapeutic plasma exchange (TPE) is an extracorporeal process that removes large harmful molecules in a variety of disease processes in critically ill children. There are two conventional modalities used to perform TPE: centrifugal (cTPE) and membrane (mTPE). Little data exists to compare their outcomes and complication rates in pediatrics, particularly for patients weighing less than 20 kilograms (kg). Our study aims to compare outcomes and complications between cTPE versus mTPE in critically ill pediatric patients.

Methods: We conducted a retrospective chart review of all children admitted to our tertiary academic center who received TPE from January 2017-December 2022. Demographic data, reason for TPE, and clinical data to evaluate study aims were collected. Quantitative analysis was performed including but not limited to Fisher’s exact and Kruskal Wallis tests as well as multivariate Poisson and Cox regressions.

Results: 61 patients met inclusion criteria with 259 TPE sessions performed (n=33/61 cTPE, n=27/61 mTPE). Those receiving cTPE had a significantly lower severity of illness compared to mTPE patients using the Pediatric Risk of Mortality (PRISM) III score (p=0.005). While accounting for these differences in illness severity, we found no differences in duration of mechanical ventilation, need for extracorporeal membrane oxygenation, and survival between the two groups. However, patients receiving cTPE did have a significantly lower length of intensive care unit stay (IRR=1.41, 95% CI 1.30-1.53, p < 0.001). Total complication rate for both modalities was 5% (n = 13/259), with significantly more in the mTPE (n=10) versus cTPE (n=3) group (p=0.021). For patients weighing less than 20kg, there were no significant differences in outcomes and complication rates.

Conclusions: Our study demonstrates minimal differences in outcomes between cTPE and mTPE with an overall low complication rate. While limited by our sample size and differences in severity of illness, we are hopeful that our findings, especially with respect to patients under 20kg, can aid in the consideration of TPE modalities for the pediatric population. Future studies with similar severity of illness scores and larger sample size are needed.