PMID- 37042579
OWN - NLM
STAT- MEDLINE
DCOM- 20231010
LR  - 20231024
IS  - 1098-1101 (Electronic)
IS  - 0733-2459 (Print)
IS  - 0733-2459 (Linking)
VI  - 38
IP  - 5
DP  - 2023 Oct
TI  - Modifications to therapeutic plasma exchange to achieve rapid exchange on 
      cardiopulmonary bypass prior to pediatric cardiac transplant.
PG  - 514-521
LID - 10.1002/jca.22053 [doi]
AB  - BACKGROUND: Cardiac transplants increasingly occur following placement of 
      ventricular assist devices (VADs). A strong association exists between human 
      leukocyte antigen (HLA) sensitization and VAD placement; however, desensitization 
      protocols that utilize therapeutic plasma exchange (TPE) are fraught with 
      technical challenges and are at increased risk of adverse events. In response to 
      increased VAD utilization in our pre-transplant population, we developed a new 
      institutional standard for TPE in the operating room. METHODS: Through a 
      multidisciplinary effort, we developed an institutional protocol for 
      intraoperative TPE immediately prior to cardiac transplantation after cannulation 
      onto cardiopulmonary bypass (CPB). All procedures used the standard TPE protocol 
      on the Terumo Optia (Terumo BCT, Lakewood, CO, USA), but incorporated multiple 
      modifications to limit patients' bypass times, and to coordinate with the 
      surgical teams. These modifications included deliberate misidentification of 
      replacement fluid and maximization of the citrate infusion rate. RESULTS: These 
      adjustments allowed the machine to run at maximal inlet speeds, minimizing 
      duration of TPE. To date, 11 patients have been treated with this protocol. All 
      survived their cardiac transplantation operation. Hypocalcemia and hypotension 
      were noted; however, none of these adverse events appeared to have clinical 
      impact. Technical complications included unexpected fibrin deposition in the TPE 
      circuit and air in the inlet line due to surgical manipulation of the CPB 
      cannula. No thromboembolic complications occurred in any patient. CONCLUSION: We 
      feel that this procedure can be rapidly and safely performed in HLA sensitized 
      pediatric patients on CPB to limit the risk of antibody mediated rejection of 
      their heart transplant.
CI  - (c) 2023 Wiley Periodicals LLC.
FAU - Davies, Emily
AU  - Davies E
AUID- ORCID: 0000-0001-5265-7520
AD  - Division of Pediatric Critical Care Medicine, Children's National Hospital, 
      Washington, District of Columbia, USA.
FAU - Khan, Sairah
AU  - Khan S
AUID- ORCID: 0000-0003-4769-0654
AD  - Division of Cardiology and Cardiac Transplant, Children's National Hospital, 
      Children's National Heart Institute, Washington, District of Columbia, USA.
FAU - Mo, Yunchuan D
AU  - Mo YD
AD  - Division of Laboratory and Transfusion Medicine, Children's National Hospital, 
      Washington, District of Columbia, USA.
AD  - Center for Cancer and Blood Disorders, Division of Hematology, Children's 
      National Hospital, Washington, District of Columbia, USA.
FAU - Jacquot, Cyril
AU  - Jacquot C
AUID- ORCID: 0000-0003-1281-0644
AD  - Division of Laboratory and Transfusion Medicine, Children's National Hospital, 
      Washington, District of Columbia, USA.
AD  - Center for Cancer and Blood Disorders, Division of Hematology, Children's 
      National Hospital, Washington, District of Columbia, USA.
FAU - Dham, Niti
AU  - Dham N
AUID- ORCID: 0000-0002-5467-0208
AD  - Division of Cardiology and Cardiac Transplant, Children's National Hospital, 
      Children's National Heart Institute, Washington, District of Columbia, USA.
FAU - Sinha, Pranava
AU  - Sinha P
AUID- ORCID: 0000-0002-5917-4668
AD  - Division of Pediatric Cardiac Surgery, Department of Surgery, University of 
      Minnesota Medical School, Minneapolis, Minnesota, USA.
FAU - Webb, Jennifer
AU  - Webb J
AUID- ORCID: 0000-0003-1463-4963
AD  - Division of Laboratory and Transfusion Medicine, Children's National Hospital, 
      Washington, District of Columbia, USA.
AD  - Center for Cancer and Blood Disorders, Division of Hematology, Children's 
      National Hospital, Washington, District of Columbia, USA.
LA  - eng
GR  - T32 HL110841/HL/NHLBI NIH HHS/United States
PT  - Journal Article
DEP - 20230412
PL  - United States
TA  - J Clin Apher
JT  - Journal of clinical apheresis
JID - 8216305
SB  - IM
MH  - Humans
MH  - Child
MH  - *Plasma Exchange/methods
MH  - Cardiopulmonary Bypass
MH  - Retrospective Studies
MH  - Plasmapheresis
MH  - *Heart Transplantation
PMC - PMC10567986
MID - NIHMS1889305
OTO - NOTNLM
OT  - allosensitization
OT  - antibody mediated rejection
OT  - cardiopulmonary bypass
OT  - donor specific crossmatch
OT  - heart transplant
OT  - therapeutic plasma exchange
OT  - ventricular assist device
COIS- Conflict of Interest: None of the authors have a conflict of interest to 
      disclose.
EDAT- 2023/04/13 06:00
MHDA- 2023/10/10 06:41
PMCR- 2024/10/01
CRDT- 2023/04/12 08:32
PHST- 2023/02/08 00:00 [revised]
PHST- 2022/08/12 00:00 [received]
PHST- 2023/03/29 00:00 [accepted]
PHST- 2024/10/01 00:00 [pmc-release]
PHST- 2023/10/10 06:41 [medline]
PHST- 2023/04/13 06:00 [pubmed]
PHST- 2023/04/12 08:32 [entrez]
AID - 10.1002/jca.22053 [doi]
PST - ppublish
SO  - J Clin Apher. 2023 Oct;38(5):514-521. doi: 10.1002/jca.22053. Epub 2023 Apr 12.