Clinical characteristics and outcomes of 144 critically ill children receiving therapeutic plasma exchange in a pediatric intensive care unit: a single-center retrospective study.

Authors

Zhijiang Chen, Qiuju Wei, Jufang Liu, Cheng Zeng, Wei Zhao

Published in

Frontiers in pediatrics. Volume 14. Pages 1955886. Epub Oct 16, 2026.

Abstract

Therapeutic plasma exchange (TPE) is increasingly used in critically ill children, yet pediatric data remain scarce. This study aimed to characterize the clinical features, indications, complications, and outcomes of children receiving TPE in a pediatric intensive care unit (PICU).
We retrospectively enrolled 144 children who underwent TPE in the PICU of Zhujiang Hospital, Southern Medical University, between January 2017 and December 2021. Demographic data, diagnoses, TPE indications (categorized according to the 2019 American Society for Apheresis [ASFA] guidelines), complications, and outcomes were collected. Multivariate logistic regression was performed to identify risk factors for mortality.
The 144 children (median age, 66 months; median Pediatric Risk of Mortality III score, 18) underwent 414 TPE sessions. The leading indications were neurological disorders (29.2%), liver diseases (19.4%), and hematologic disorders (16.7%); 57.6% of patients were treated for ASFA category III indications. The complication rate was 16.9% per session, with filter or circuit clotting the most frequent event (7.2%); all complications resolved after prompt management, and no treatment-related death occurred. Overall PICU mortality was 36.8%, highest in the liver disease group (60.7%) and lowest in the neurological disorder group (16.7%) (P = 0.012). Non-survivors had higher rates of multiple organ dysfunction syndrome (MODS), mechanical ventilation, and vasopressor use than survivors (all P < 0.001). Multivariate analysis identified MODS (odds ratio [OR] = 5.609, 95% confidence interval [CI]: 1.189-26.453) and vasopressor use (OR = 6.551, 95% CI: 1.310-32.768) as independent risk factors for mortality.
TPE is generally safe in critically ill children when performed in an experienced PICU. MODS and vasopressor requirement independently predicted death. Because no control group was included, treatment efficacy could not be evaluated; our conclusions are limited to the safety and clinical profile of TPE in this population.

PMID:
42964209
Bibliographic data and abstract were imported from PubMed on 31 Oct 2026.

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