#847 Experience with therapeutic apheresis in a tertiary level hospital over the last 25 years
Authors: Ruiz Aránzazu Pardo , Galarreta Esther Najera , Espinoza Karla Jackeline López , Bengoa Guillermo Pereda , Larrañaga Marta Artamendi , Ovalles Altagracia Elisa Bello , Santana Laura Sahdala , Pacheco Celia Garijo , Catalinas Fernando Gil , Loza Emma Huarte 
Published: May 2024

Abstract

Background and Aims
The main purpose of therapeutic apheresis is the extraction and elimination from plasma of those components considered to be responsible for the pathogenesis of a disease, the replacement of deficient factors and the improvement of the function of the reticuloendothelial system and certain inflammatory mediators.
Currently, it constitutes a good therapeutic alternative for the treatment of a wide variety of diseases of different specialties, where conventional treatment has not been successful or the desired response has not been obtained. In general, apheresis is a beneficial technique, well tolerated and with few complications. Requests for apheresis are increasingly frequent from different areas of daily clinical practice.

Method
Descriptive-retrospective cohort study, in which all the apheresis sessions performed in our department between January 1997 and February 2023 were analyzed. The aim of this study is to describe the experience with plasmapheresis performed by nephrologists in patients with different diseases.
We analyzed the following variables: sex, age, underlying disease and indication according to the American Society for Apheresis (ASFA) classification, apheresis technique and number of sessions performed. In the last 5 years (2018-2023) we also evaluated: plasma replacement, vascular access and complications during the performance of the technique.

Results
During the period January 1997-February 2023 a total of 2483 sessions were performed. Of the sessions, 76% were plasmapheresis, 20.5% granulocytapheresis and 3% lipid apheresis.
Apheresis was performed in 199 patients, 57% men (114), 42.5% women (85), with a mean age of 51 years. The average number of sessions per patient during the follow-up of their disease was 13 sessions.
The main causes for which apheresis was performed were neurological diseases, 34.5% of the cases, including Myasthenia Gravis (41%), Guillain-Barré (29%). In second place, autoimmune nephrological diseases in 27%, rejection of transplanted organs in 27%, hematological diseases in 7.5% and metabolic diseases in 3.5%.
Almost 70% of the indications corresponded to ASFA grade I and II evidence criteria.
Focusing on the last 5 years, the services from which we were requested to perform the technique were mainly Neurology, Hematology, Digestive and Internal Medicine.
The pathologies treated by apheresis were: 39% neurological diseases, 39% renal pathology (50% autoimmune diseases and 50% due to rejection of a transplanted organ) and 17% hematological diseases.
According to ASFA criteria, the prevalent category was ASFA I (32%), followed by ASFA III (31%), ASFA II (24%), and finally ASFA IV (9.8%).
Plasma replacement was performed with albumin in 63.4% of the cases, with fresh plasma in 22% of the cases and with both in 9.8% of the sessions.
In relation to the technique, the complications observed were infrequent (14%), being fundamentally paresthesia, nausea, allergic reactions of a self-limited nature and with adequate control with premedication in subsequent sessions. Other less frequent complications were: hypotension or catheter dysfunction.

Conclusion