Three decades of experience with therapeutic apheresis at a tertiary academic center: review of indications, clinical practice, special age groups and complications.

introductionWe performed a comprehensive retrospective analysis of 30-year therapeutic apheresis (TA) activity and practices at one a national apheresis center in Slovenia to describe trends and main TA characteristics.

methodsWe retrospectively reviewed the medical records of all TA procedures from 1986 to 2016 and extracted indications, vascular access, number of procedures and complications. We compared two time periods (1986–2000 vs. 2001–2016) and analyzed two age subgroups (children and elderly). For the most recent patient cohort (2010 to 2016) we retrieved additional parameters pertaining to each TA procedure.

resultsThe whole cohort included 1,132 patients who underwent a total of 14,082 apheresis procedures. Central venous catheters were predominantly used, with a trend toward greater use of arterio-venous fistulas in the later period. The number of procedures increased over time. The use of lipid apheresis was stable, and the use of immunoadsorption declined in recent years. The use of apheresis for some indications increased, whereas other indications remained stable over the years. The comparison of the two time periods revealed increased utilization of the TA, increasing patient age, and a shift in vascular access type. In pediatric and elderly patient populations, the indications differed substantially. Chronic apheresis was utilized in a distinct subset of patients. Our analysis confirmed that TA was generally safe and had a low incidence of complications. The most common adverse events were hypotension and mild allergic reactions. Only 0.6% of the procedures were stopped because of a complication.

conclusionOur study provides valuable insights into TA practices over three decades. This finding underscores the importance of vascular access in apheresis treatment and reaffirms the safety profile of TA across different age groups. Our center’s collaborative approach to providing TA under nephrologist supervision has proven effective in managing changes in the field of apheresis and ensuring patient safety.