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Abstract: TH-PO042

Safety and Clinical Efficacy of Plasma-Saving Membrane-Based Therapeutic Plasma Exchange (mTPE) in the Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials


  • Ahn, Jae Sung, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)

The mTPE eliminating endotoxin, cytokine and abnormal antibody could be beneficial. To minimize adverse reaction caused by fresh frozen plasma (FFP) and bleeding risk, we used 5-20% albumin, crystalloid fluid and 8 units of FFP as replacement solution. We investigated bleeding event, the changes of platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and 28-Day mortality rate as primary outcome.


In this retrospective study, 118 mTPE sessions were performed in 60 patients (age 59.6±14.4 years, M:F=34:26) undergoing CRRT and receiving antibiotics and vasopressors for severe sepsis/shock (n=43), inflammatory disease (n=12) and others (n=5). Our subjects were divided into four groups according to the SOFA score: I (0-9, predicted mortality rate <10%), II (10-12, 10-30%), III (13-14, 40-60%), and IV (15-24, > 75%). mTPE was repeated with the interval of 24-48 hours up to 10 times, If needed.


There was no significant difference in SOFA scores, mean arterial pressure, vasopressor index score and PT. The hemoglobin (8.8±2.0 vs. 8.4±2.0 g/dL, p=0.021) and platelet count (96K±101K vs. 80K±86K /mm3, p=0.001) were significantly decreased after 1st mTPE. aPTT was significantly increased from 62.7±38.6 to 74.5±41.2 seconds (p=0.037). The similar changes persisted after 2nd mTPE. However, there was no bleeding event within 24 hours from the end of mTPE sessions. The 28-Day mortality rates were 22.2%, 12.5%, 0% and 67.6% in the 4 groups, respectively. Analyzing survival according to the number of mTPE application, 14 patients survived among 29 who received only one time of mTPE and 4 among 20, two times of mTPE. Only 2 patients survived among 11 who received three time or more of mTPE.


Despite aPTT prolongation and decreased hemoglobin and platelet count, no bleeding events and lower-than-expected mortality suggest that mTPE could be safe and beneficial in these patients.