TY - JOUR T1 - Decreasing frequency of plasma exchange complications in patients treated for thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, 1996 to 2011. JF - Transfusion//Transfusion Y1 - 2012 A1 - Som, Sumit A1 - Deford, Cassandra C A1 - Kaiser, Mandi L A1 - Terrell, Deirdra R A1 - Kremer Hovinga, Johanna A A1 - Lammle, Bernhard A1 - George, James N A1 - Vesely, Sara K KW - *Hemolytic-Uremic Syndrome/mo [Mortality] KW - *Hemolytic-Uremic Syndrome/th [Therapy] KW - *Plasma Exchange/ae [Adverse Effects] KW - *Plasma Exchange/mo [Mortality] KW - *Purpura, Thrombotic Thrombocytopenic/mo [Mortality] KW - *Purpura, Thrombotic Thrombocytopenic/th [Therapy] KW - ADAM Proteins/me [Metabolism] KW - Adrenal Cortex Hormones/tu [Therapeutic Use] KW - Adult KW - Antibodies, Monoclonal, Murine-Derived/tu [Therapeutic Use] KW - Antineoplastic Agents/tu [Therapeutic Use] KW - Catheter-Related Infections/mo [Mortality] KW - Catheterization, Central Venous/ae [Adverse Effects] KW - Education, Medical, Continuing KW - Female KW - Hemolytic-Uremic Syndrome/dt [Drug Therapy] KW - Humans KW - Male KW - Morbidity KW - Oklahoma/ep [Epidemiology] KW - Purpura, Thrombotic Thrombocytopenic/dt [Drug Therapy] KW - Registries/sn [Statistics & Numerical Data] KW - Remission Induction KW - Risk Factors KW - rituximab KW - Sepsis/mo [Mortality] AB - BACKGROUND: Plasma exchange (PEX) treatment for patients with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) has risk for major complications., STUDY DESIGN AND METHODS: Data for PEX-related complications have been prospectively collected on all patients enrolled in the Oklahoma TTP-HUS Registry, 1996 to 2011. PEX-related complications have been defined as major or minor and as central venous catheter related or plasma related., RESULTS: During 15 years, 1996 to 2011, 72 (24%) of 302 consecutive patients had major PEX-related complications. Analysis of five consecutive 3-year cohorts demonstrated that there has been a significant trend for decreasing frequency of all PEX-related major complications (p = 0.014) and central venous catheter-related major complications (p = 0.021) but not for the less common plasma-related major complications (p = 0.380). ADAMTS13 activity was measured in 288 (95%) of the 302 patients. Analysis of the 66 patients with ADAMTS13 activity of less than 10% demonstrated a significant trend for decreasing frequency of PEX-related major complications (p = 0.036); the trend for the 222 patients with ADAMTS13 activity of at least 10% was not significant (p = 0.118). The decreased frequency of PEX-related major complications among patients with ADAMTS13 activity of less than 10% may be related to a significant trend for decreasing duration of PEX treatment (p = 0.040) and decreasing frequency of requirement for more than one central venous catheter (p = 0.044). The decreased duration of PEX treatment may be related to increased use of adjunctive treatments: corticosteroids (p < 0.001) and rituximab (p < 0.001)., CONCLUSIONS: The frequency of PEX-related major complications has decreased from 1996 to 2011, possibly related to increased use of corticosteroids and rituximab and the decreased duration of PEX required to achieve remission.Copyright © 2012 American Association of Blood Banks. M1 - wdn, 0417360 CY - United States VL - 52 SN - 1537-2995 CP - 12 N1 - Comment in: Transfusion. 2012 Dec;52(12):2498-501; PMID: 23231672 L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medl&NEWS=N&AN=22501034 ID - 4572 ER -