Infectious Complications in Adult ABO-Incompatible Liver Transplantation: Our Preliminary Experience

The number of ABO-incompatible living donor liver transplantations (ABO-I LDLT) has increased owing to the use of preoperative rituximab for immunosuppression. However, controversy remains regarding adequate immunosuppression owing to rejection and infection. Here, we present 5 cases of our ABO-I LDLT experience, emphasizing rejection and infectious complications, retrospectively. The treatment protocol included prophylactic rituximab followed by plasma exchange prior to transplantation, splenectomy, and immunosuppressive and prophylactic antibiotic regimens after transplantation. Four of the 5 patients also received local infusion therapy via the portal vein. Neither hyperacute nor antibody-mediated rejection occurred. All grafts were functioning well at discharge. Rehospitalization was required for 2 patients due to severe infection within 6 months of transplantation. Invasive aspergillosis was successfully treated in 1 patient, but the other patient died from severe sepsis with overwhelming postsplenectomy infection syndrome. Our results confirm that, although improved immunosuppressive therapy markedly reduces rejection in ABO-I LDLT, it is also associated with an increased risk of various life-threatening infections.

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Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study

PLoS ONE ◽

10.1371/journal.pone.0250829 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250829

Author(s):

Nancy Perrottet ◽

Mario Fernández-Ruiz ◽

Isabelle Binet ◽

Michael Dickenmann ◽

Suzan Dahdal ◽

...

Keyword(s):

Cohort Study ◽

Kidney Transplantation ◽

Real Life ◽

Severe Infection ◽

Intravenous Immunoglobulins ◽

Infectious Complications ◽

Treatment Recommendation ◽

Accurate Information ◽

Significant Heterogeneity ◽

Antibody Mediated Rejection

Acute antibody-mediated rejection (AMR) remains a challenge after kidney transplantation (KT). As there is no clear-cut treatment recommendation, accurate information on current therapeutic strategies in real-life practice is needed. KT recipients from the multicenter Swiss Transplant Cohort Study treated for acute AMR during the first post-transplant year were included retrospectively. We aimed at describing the anti-rejection protocols used routinely, as well as patient and graft outcomes, with focus on infectious complications. Overall, 65/1669 (3.9%) KT recipients were treated for 75 episodes of acute AMR. In addition to corticosteroid boluses, most common therapies included plasmapheresis (56.0%), intravenous immunoglobulins (IVIg) (38.7%), rituximab (25.3%), and antithymocyte globulin (22.7%). At least one infectious complication occurred within 6 months from AMR treatment in 63.6% of patients. Plasmapheresis increased the risk of overall (hazard ratio [HR]: 2.89; P-value = 0.002) and opportunistic infection (HR: 5.32; P-value = 0.033). IVIg exerted a protective effect for bacterial infection (HR: 0.29; P-value = 0.053). The recovery of renal function was complete at 3 months after AMR treatment in 67% of episodes. One-year death-censored graft survival was 90.9%. Four patients (6.2%) died during the first year (two due to severe infection). In this nationwide cohort we found significant heterogeneity in therapeutic approaches for acute AMR. Infectious complications were common, particularly among KT recipients receiving plasmapheresis.

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Adult Living Donor Liver Transplantation with ABO-Incompatible Grafts: A German Single Center Experience

Journal of Transplantation ◽

10.1155/2009/759581 ◽

2009 ◽

Vol 2009 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Armin D. Goralczyk ◽

Aiman Obed ◽

Andreas Schnitzbauer ◽

Axel Doenecke ◽

Tung Yu Tsui ◽

...

Keyword(s):

Blood Group ◽

Living Donor ◽

Graft Function ◽

Abo Blood Group ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Antibody Mediated Rejection ◽

Single Center Experience ◽

Liver Transplantations ◽

No Gold Standard

Adult living donor liver transplantations (ALDLTs) across the ABO blood group barrier have been reported in Asia, North Americas, and Europe, but not yet in Germany. Several strategies have been established to overcome the detrimental effects that are attached with such a disparity between donor and host, but no gold standard has yet emerged. Here, we present the first experiences with three ABO-incompatible adult living donor liver transplantations in Germany applying different immunosuppressive strategies. Four patient-donor couples were considered for ABO-incompatible ALDLT. In these patients, resident ABO blood group antibodies (isoagglutinins) were depleted by plasmapheresis or immunoadsorption and replenishment was inhibited by splenectomy and/or B-cell-targeted immunosuppression. Despite different treatments ALDLT could safely be performed in three patients and all patients had good initial graft function without signs for antibody-mediated rejection (AMR). Two patients had long-term graft survival with stable graft function. We thus propose the feasibility of ABO-incompatible ALDLT with these protocols and advocate further expansion of ABO incompatible ALDLT in multicenter trials to improve efficacy and safety.

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COVID-19 and Rheumatology: so far, so close

Medical Council ◽

10.21518/2079-701x-2020-8-135-143 ◽

2020 ◽

pp. 135-143

Author(s):

B. S. Belov ◽

N. M. Muravyeva ◽

G. M. Tarasova

Keyword(s):

Pneumococcal Infection ◽

Infectious Complications ◽

Inflammatory Rheumatic Diseases ◽

Prophylactic Efficacy ◽

Extreme Caution ◽

Increased Risk ◽

Life Threatening ◽

Tract Involvement ◽

Social Importance

The disease caused by the new coronavirus COVID-19 is considered by the world community as an emergency of internationalimportance. Along with the huge social importance, the COVID-19 pandemic has highlighted a number of principally new clinical and fundamental problems of immunopathology of human diseases. This problem is extremely urgent for patients suffering from immune-inflammatory rheumatic diseases (IIRD) due to their higher exposure to infectious complications. Achieving and maintaining control over the activity of IIRD plays an important role in reducing the incidence of comorbid infections in these patients. It has been shown that patients with IIRD undergoing active anti-rheumatic therapy are most likely not characterized by increased risk of respiratory or other life-threatening complications within COVID-19 compared to the general population. Given the need for continued monitoring of patients receiving these therapy, unjustified “prophylactic” cancellation should nevertheless be avoided, thereby increasing the risk of relapse of major IIRD. The article also discusses the issues related to the use of basic anti-rheumatic drugs in COVID-19. Currently there is no evidence to support the therapeutic and prophylactic efficacy of chloroquine or hydroxychloroquine in COVID-19. Tocilizumab can be considered as “lifesaving therapy” for patients with acute respiratory distress syndrome in COVID-19, if other treatments have failed or are unavailable. The use of baricitinib in hospitalized pneumonia patients as part of COVID-19 should be considered with extreme caution. The need for further research to assess the potential role of baricitinib for these patients is highlighted. In the absence of a COVID-19 vaccine in a continuing pandemic, vaccination against influenza and pneumococcal infection should be strongly recommended to the absolute majority of patients with IIRD. This is associated with a high risk of fatal respiratory infection in rheumatological patients, especially given the high respiratory tract involvement in COVID-19.

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SARS-CoV-2 Infection in Kidney Transplant Recipients: A Single-Centre Study of 20 Cases from India

International Journal of Nephrology ◽

10.1155/2021/2243095 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Ravi Raju Tatapudi ◽

Venkateswara Rao Kopparti ◽

Anusha Poosapati ◽

Srinivas Metta ◽

Atchyutha Rao Gongada ◽

...

Keyword(s):

Kidney Transplant ◽

Survival Rates ◽

Antiviral Drug ◽

Treatment Protocol ◽

Severe Infection ◽

Hospitalized Patients ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Increased Risk ◽

Therapeutic Protocols

Introduction. The second wave of COVID-19 has spread across India causing unprecedented misery to people since March 2021. Kidney transplant recipients (KTRs) are at an increased risk of severe infection. Their outcomes appear to be worse than those in the general population. There is no robust evidence or consensus to support any form of treatment protocol or modification of immunosuppression in KTRs with COVID-19. There is a need to develop effective and safe therapeutic protocols for this frail population. Remdesivir is the only approved antiviral drug in COVID-19 till now. Methods. We describe clinical features, role of HRCT, therapeutic protocols, and mortality rate of 20 KTRs with SARS-CoV-2 infection. Results. Complete recovery was seen in 8 (40%) patients monitored at home. 12 (60%) patients with HRCT scores more than 8/25 were hospitalized. 11 (55%) had hypoxia, of these 8 (40%) had mild hypoxia, 1 (5%) required NIV, and 2 (10%) needed mechanical ventilation. Immunosuppression was modified in all the patients. Remdesivir and dexamethasone were administered to the hospitalized patients. 1 (5%) patient had AKI requiring RRT. 1 (5%) patient expired, and 1 still hospitalized. 10 of the hospitalized patients recovered. Out of the total 20 patients, 18 (90%) recovered completely within two weeks of infection. Conclusion. Clinical presentation of COVID-19 in KTRs was similar to nontransplant patients. Early hospitalisation and assessing the severity by HRCT were important. Continuing tacrolimus and administering remdesivir and dexamethasone reduced the incidence of renal failure and improved survival rates.

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Antibiotic Prophylaxis in Transarterial Therapy of Hepatocellular Carcinoma: A Meta-Analysis

Canadian Journal of Gastroenterology ◽

10.1155/2012/375956 ◽

2012 ◽

Vol 26 (2) ◽

pp. 85-91 ◽

Cited By ~ 3

Author(s):

Jun Wang ◽

Xiao Dong He ◽

You Cheng Zhang

Keyword(s):

Hepatocellular Carcinoma ◽

Antibiotic Prophylaxis ◽

Antibiotic Treatment ◽

Meta Analysis ◽

Survival Rates ◽

Prophylactic Antibiotic ◽

Infectious Complications ◽

Bibliographic Databases ◽

Increased Risk ◽

Prophylactic Antibiotic Treatment

Transarterial therapies, either alone or in conjunction with adjuvant therapies, have been demonstrated to improve survival rates in patients with hepatocellular carcinoma (HCC). Although generally well tolerated and widely used for more than two decades, transarterial procedures have been reported to be associated with several infectious complications when performed in patients with HCC. However, the question of whether antibiotic prophylaxis is necessary for patients undergoing transarterial procedures for HCC remains controversial. Accordingly, this meta-analysis examined clinical trial evidence regarding the effects of prophylactic antibiotic therapy versus no prophylactic treatment with respect to infectious complications in patients undergoing transarterial therapy for HCC.BACKGROUND: The use of prophylactic antibiotics against postprocedure infection in patients undergoing transarterial therapy for hepatocellular carcinoma is controversial.AIM: To compare the effects of prophylactic antibiotic treatment and no prophylactic antibiotic treatment on infectious complications following transarterial procedures.METHODS: Clinical trials fulfilling predefined selection criteria were identified by searching several bibliographic databases; a meta-analysis was performed where appropriate.RESULTS: Four trials of inadequate quality consisting of 210 patients were included in the analysis. Only one case of possible postprocedure infection in each group was reported. The rate of patients developing fever (RR 0.91 [95% CI 0.61 to 1.35]), changes in peripheral white blood cell count or serum C-reactive protein levels, and the mean length of hospital stay (mean difference 0.20 [95% CI 0.75 to 1.14]) showed no significant intergroup differences between antibiotic and no antibiotic treatment. Furthermore, the results of the present study indicated that the incidence of bacteremia, septicemia, sepsis or hepatic abscess after transarterial therapy was rare.CONCLUSION: Antibiotic prophylaxis in patients undergoing transarterial therapy for hepatocellular carcinoma may not be routinely necessary. However, a more judicious use of antibiotics is recommended for patients who are at an increased risk of infection. Nevertheless, prospective trials on a larger scale are clearly needed.

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Preoperative hyponatremia predicts complications in older patients undergoing digestive tract surgery: a propensity score matching analysis

European Geriatric Medicine ◽

10.1007/s41999-021-00559-4 ◽

2021 ◽

Author(s):

Chun-Qing Li ◽

Chen Zhang ◽

Fan Yu ◽

Hao Kong ◽

Chun-Mei Deng

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

Propensity Score Matching ◽

Digestive Tract ◽

Older Patients ◽

Infectious Complications ◽

Increased Risk ◽

Life Threatening ◽

Digestive Tract Surgery ◽

Complications And Mortality

Abstract Purpose Whether preoperative hyponatremia increases the risk of postoperative complications in older patients undergoing digestive tract surgery remains unclear. The purpose of the study was to investigate the association between preoperative hyponatremia and life-threatening postoperative complications (including death) among older patients undergoing digestive tract surgery. Methods This was a propensity score-matched, retrospective cohort study. We recruited older patients (≥ 65 years of age) who underwent digestive tract surgery in our institution. The propensity score matching (PSM; 1:2) was used to balance a range of covariates between patients with preoperative hyponatremia (serum sodium [Na+] levels < 135 mmol/L) and those with normal [Na+] levels (135–145 mmol/L). The primary outcome was the occurrence of life-threatening postoperative complications and mortality (i.e., Clavien–Dindo grade IV and V [CD IV and V] complications) during hospital stay. The relationship between preoperative hyponatremia and the development of CD IV and V complications was identified with logistic regression analysis. Results A total of 1076 patients were analyzed (mean age 73.9 years; 421 female [39.1%]). Preoperative hyponatremia was identified in 122 patients. After matching, 312 patients were included in the analyses (104 patients with preoperative hyponatremia and 208 patients with normal [Na+] levels; mean age, 76.3 years; 130 female [41.7%]). When compared with normal [Na+] levels, preoperative hyponatremia was associated with an increased risk of CD IV and V complications (odds ratio [OR] 2.082, 95% confidential interval [CI] 1.041–4.164, P = 0.038). Preoperative hyponatremia was also significantly associated with a higher risk of postoperative infectious complications (OR 2.158, 95% CI 1.138–4.091, P = 0.018). Conclusion Preoperative hyponatremia can predict an increased risk of life-threatening postoperative complications and mortality in older patients undergoing digestive tract surgery.

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Predictive Factors to Hypogammaglobulinemia and Non-Neutropenic Infection Complications after Rituximab/Chemotherapy Treatment

Blood ◽

10.1182/blood.v110.11.1288.1288 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1288-1288 ◽

Cited By ~ 4

Author(s):

Kalman Filanovsky ◽

Lev Shvidel ◽

Mordechai Shtalrid ◽

Michal Haran ◽

Adrian Duek ◽

...

Keyword(s):

Multivariate Analysis ◽

Chemotherapy Regimen ◽

Bone Marrow Involvement ◽

Severe Infection ◽

Infectious Complications ◽

Immunoglobulin Level ◽

Increased Risk ◽

Severe Infections ◽

Related Mortality

Abstract Rituximab is a chimerical human/mouse monoclonal anti-CD20 antibody successfully applied in B-cell lymphoproliferative disorders. The suppression of B-lymphocytes may induce hypogammaglobulinemia and increased risk for infection. These complications are rarely observed as a result of monotherapy with rituximab but have been often noted following combination with aggressive chemotherapy or in the setting of autologous stem cell transplantation (ASCT). In an attempt to study the role of rituximab in induction of hypogamma, we analyzed the frequency of this phenomenon, its possible causes, infectious complications and infection-related mortality in lymphoma patients treated with different chemotherapy regimens with or without rituximab. We analyzed 136 patients who received rituximab concurrently with chemotherapy (R-Chemo) and 46 patients who were treated with chemotherapy only, with follow-up period of up to five years. Following R-Chemo, 17 cases (12.5%) of severe hypogamma (defined as <60% of normal IgG range) were diagnosed, 21 patients (15.5%) had mild and moderate hypogammaglobulinemia, and 16 (12%) were found with decreased IgM alone. Multivariate analysis showed a significant increase of severe hypogamma when >6 doses of rituximab were given. Moreover, rituximab in >8 doses leaded to severe hypogamma in 50% of patients compared to 11.8% in patients treated with <8 doses (p .006) associated with 3 times more infections. The type of chemotherapy regimen didn’t influence development of the hypogamma. Even myeloablative chemotherapy used in combination with rituximab before ASCT slightly increased the rate of severe hypogamma (p .06). Only the combination of fludarabine and rituximab (FR) compared to other Chemo-R, induced non-significant increase of severe hypogammaglobulinemia (21% vs 11%; p .02), severe non-neutropenic infection 19.4% vs 5.0% (p .005) and infection-related mortality 24% vs. 6% (p. 004). Multivariate analysis showed that patients post FR treatment were 6.4 times more prone to have severe infections than post other Chemo-R regimens (95% CI 1.49–27.0). Age and gender of patients, type of lymphoma, bone marrow involvement didn’t affect the immunoglobulin level. We found a strong correlation between the IgG level and frequency of severe infections and mortality from infection (p <.01). Finally, the pre-treatment hypogamma was not found as a risk factor for infection. However, the duration of this phenomenon was found important: patients with severe hypogamma lasted >6 months were 4.5 times more likely to have severe infection (95%CI 1.19–18.5). In conclusion, we emphasized the importance of follow-up on immunoglobulin level in patients receiving rituximab. Hypogammoglobulinemia is not rare and is a clinical important phenomenon, leading to increase in infection and mortality rate in patients receiving R-Chemo. Longer treatment with more than six doses of rituximab significantly increases the incidence of hypogammoglobulinemia. The type chemotherapy regimen, except for fludarabine didn’t affect the incidence of hypogammaglobulinemia and infection rate in our patients.

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Lymphocytopenia Is Associated with an Increased Risk of Severe Infections in Patients with Multiple Myeloma Treated with Bortezomib-Based Regimens

Blood ◽

10.1182/blood.v120.21.5042.5042 ◽

2012 ◽

Vol 120 (21) ◽

pp. 5042-5042 ◽

Cited By ~ 1

Author(s):

Sung-Hoon Jung ◽

Jae-Sook Ahn ◽

Seung-Ji Kang ◽

Deok-Hwan Yang ◽

Yeo-Kyeoung Kim ◽

...

Keyword(s):

Multiple Myeloma ◽

Multivariate Analysis ◽

Conflicts Of Interest ◽

Severe Infection ◽

Infectious Complications ◽

P Value ◽

Factors Affecting ◽

Increased Risk ◽

Severe Infections ◽

Grade 3

Abstract Abstract 5042 Bortezomib is a proteasome inhibitor with potent antimyeloma activity in relapsed/refractory multiple myeloma (MM) patients. We evaluated the type and factors affecting the onset of infectious complications and mortality owing to infection in MM patients treated with bortezomib-based regimens. We reviewed 139 patients with MM treated with regimens containing bortezomib in order to assess the type and factors affecting the development of severe infections. Infections occurred in 56 (40. 3%) of 139 patients and 83 (7. 8%) cases of the 1, 069 evaluable cycles. Severe infections developed in 43 (30. 9%) patients and ten patients (7. 1%) died during bortezomib-based treatment. Multivariate analysis determined lymphocytopenia grade 3–4 (OR 3. 17, 95% CI 1. 38–7. 31, p = 0. 007) and number of cycle ° Â 8 cycles (OR 3. 91, 95% CI 1. 39–11. 02, p =0. 010) as risk factors associated with increased severe infection. This study showed that MM patients who received bortezomib-based regimens are at a higher risk of severe infections within eight cycles of treatment during especially severe lymphocytopenic period. MM patients treated with bortezomib-based regimens should be closely monitored for the development of infectious complications during lymphocytopenia. Table I. Multivariate analysis of factors affecting severe infection development Parameter OR (95% CI) p-Value Age (> 65) 1.78 (0.77–4.13) 0.180 Immunophenotype IgA 1.51 (0.60–3.77) 0.379 Lymphocytopenia (grade 3–4) 3.17 (1.38–7.31) 0.007 Neutropenia (grade 3–4) 1.25 (0.55–2.85) 0.600 Number of cycles (°Â 8 cycles) 3.91 (1.39–11.02) 0.010 Disclosures: No relevant conflicts of interest to declare.

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Accompanying therapy in oncohematological patients with secondary immunodeficiency

Modern Oncology ◽

10.26442/18151434.2020.2.200127 ◽

2020 ◽

Vol 22 (2) ◽

pp. 89-97

Author(s):

Lali G. Babicheva ◽

Irina V. Poddubnaya

Keyword(s):

Immune System ◽

Replacement Therapy ◽

Hematopoietic Cell Transplantation ◽

Case Fatality ◽

Severe Infection ◽

Infectious Complications ◽

Lymphocytic Leukemia ◽

Secondary Immunodeficiency ◽

Increased Risk ◽

Starting Point

Actuality. The inability of a persons immune system to withstand foreign antigenic aggression is called immunodeficiency. More than 1/2 of all cases of secondary immunodeficiency (SID) in the world are occupied by hemoblastosis and, in a greater degree, the therapy, accompanied by the immunosuppression. Due to the expansion of the arsenal of new targeted drugs for the treatment of oncohematological diseases affecting different parts of the immune system, to increasingly frequent use of autologous and especially allogeneic hematopoietic cell transplantation, the prevalence and the frequency of SID are inexorably increasing. Timely diagnosis of SID should be the starting point of the management of oncohematological patients to reduce the incidence of infectious complications and, as a result, case fatality rate. Monitoring is based on assessing risk factors and identifying the category of patients requiring active preventive measures before they develop severe infection. Elimination of the main cause of SID development is the preferred option for the prevention of the infectious complications. However, in case of multiple myeloma, chronic lymphocytic leukemia and other oncohematological diseases, this option is often impossible. Therefore, active accompanying therapy is necessary for this category of patients, in particular immunoglobulin (Ig) replacement therapy. Main clinical communities are currently in the process of updating their guidelines and recommendations on using Ig replacement therapy in patients with hemoblastosis accompanied severe recurrent infections; after ineffective antibiotic treatment; with a proven inadequate specific antibody response; IgG4 g/l. Numerous cohort, observational and randomized trials showed the significant reduction in the number of infectious complications in oncohematological patients on using long-term (not less than 1012 months) intravenous Ig replacement therapy. The lack of attention of oncologists and hematologists to the early diagnosis and prevention of these conditions leads to the increase in the number of infectious complications with all the consequences such as worsen treatment results and increase mortality among oncohematological patients. Conclusion. There is a real need to raise awareness among physicians and patients, to use screening and better management of the group of patients with increased risk of SID, and preventive use of intravenous Ig to reduce the incidence of infectious complications and active accompanying therapy aimed at reducing infection-related mortality.

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Therapeutic Plasma Exchange in Pediatrics for Immunologic Disorders; Tolerated and Safe Process for Pediatric Life-Threatening Conditions

Blood ◽

10.1182/blood-2019-122106 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4986-4986

Author(s):

Jean-Sebastien Diana ◽

Sandra Manceau ◽

Tioka Rabeony ◽

Caroline Elie ◽

anne-Marine Lenzotti ◽

...

Keyword(s):

Plasma Exchange ◽

Inflammatory Diseases ◽

Therapeutic Plasma Exchange ◽

Renal Diseases ◽

Case Report Form ◽

Solid Organ ◽

Immune Disorder ◽

Antibody Mediated Rejection ◽

Increased Risk ◽

Life Threatening

Therapeutic plasma exchange (TPE) is advocated as a treatment to several conditions and applications: solid organs transplantation, kidney and pediatric immune disorder. Apheresis for children diseases has been poorly investigated in mostly small, uncontrolled studies.The purpose was to report our experience, and provide uniform and relatable data, in order to improve disease management. We included 94 patients, aged under 18 years old, who underwent TPE in the pediatric center of Necker-Enfants-Malades hospital from January 2005 to December 2014. Data were retrospectively collected in an electronic case report form via a web-based data collection system. 78 patients were selected, including 36 females and 42 males with a median age of 9.78 years [range 0.53; 17.93]. They achieved a total number of 731 procedures. Indications were antibody-mediated rejection (n= 33; 42%) or desensitization therapy (n= 5; 6%) for solid organ or hematopoietic transplantations; microangiopathy (n= 17; 22%); renal diseases (n= 6; 8%) and pediatric inflammatory diseases (n= 16; 21%); or hyperviscosity syndrome (n = 1; 1%). Each patient had an average of 6 procedures for the first session [range 1; 19] with a median volume of 1834 ml [range 500; 5000 ml] corresponding to a median total plasma volume (TPV) equivalent of 1.39 l/m2[range: 0.58; 2.1 l/m2].Within 15 days in the beginning of the sessions, 72 patients (92%) presented a total of 311 Advers Events(AEs) potentially related to TPE. 94 AEs were not related to TPE sessions.There was a median of 5 AEs/patients [range: 0; 24]. There was no significant increased risk of AEs due to diseases, intensity of care, venous access, plasma substitute and body weight. Few of AEs were potentially life-threatening and concerned pediatric critical care situations. Allergic reactions represented only 20 AEs for 14 patients (grade I n= 18; grade II n= 1; grade III n= 1). At the endpoint of M12, 15 (19%) patients had died, no death had been related to the TPE process. Nine patients performed a second or a third session of procedures and 10 (13%) patients had severe persistent clinical disease. We describe one of the largest retrospective pediatric cohort to date, to the last international recommendations. Our experience on children TPE feasibility concern specific life‐threatening conditions and otherwise potential refractory diseases. TPE were generally well tolerated and the majority of the adverse effects were anticipated and could therefore be avoided. Based on this work, and in order to progress in the understanding of the TPE field, it would be interesting to increase pediatric data with prospective and multicenter cohort. Disclosures Cavazzana: Smartimmune: Other: Founder of Smartimmune.

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