Therapeutic Plasma Exchange in Pediatric Multi-organ Dysfunction Syndrome- Single Centre Experience

The use of Therapeutic Plasma Exchange (TPE) as an adjunctive treatment for plasma failure and Multi-organ dysfunction (MODS) has been on the rise over the past few years with very few published studies in children. METHODOLOGY: This is a post-hoc analysis of prospectively collected data from a Quaternary-Care Children's Hospital between August 2021 and August 2024. Children from one-month to eighteen-years of age, who underwent TPE for MODS were enrolled. Children who received TPE for Primary Liver Disorder, Primary Neurological Conditions without MODS, and Post-Solid organ transplantation were excluded from the study. RESULTS: 4626 children were admitted during the study period, out of which 82 children underwent TPE for various reasons while 29 children received TPE primarily for Paediatric MODS. Youngest being 8-month old. Causes of MODS in these children were Dengue (51%) followed by Influenza illness (14%), COVID-19 (3.4%), Bacterial Sepsis (20%), combined bacterial and viral infection (3.4%), envenomation (3.4%), and malignancy (3.4%). 14 (49%) children receiving TPE had Thrombocytopenia associated Multi-organ Failure (TAMOF), while 8 (27%) children had Hyperferritenemic MODS. There were 7 (24%) children who had acute necrotizing encephalitis with MODS. There was significant improvement in Sequential Organ Failure Assessment (SOFA) score and Vaso-active inotropes(VIS) score at the end of 48 hours of initiation amongst survivors (p-Value-0.0006 and 0.0222 respectively) Multivariate regression showed that the organ failure index (OFI) at the time of admission was significantly associated with mortality. With each unit increase in OFI, the probability of death increased by 2.72 times (adjusted OR: 2.72; 95% CI: 1.09 to 6.84). No major procedure-related adverse events were reported during TPE. CONCLUSION: TPE in Pediatric MODS is feasible option. Survivors demonstrated an improvement in hemodynamics and organ failure scores on TPE. Larger multi-centric pediatric studies will be helpful in defining the clear role of TPE in pediatric MODS.