Abstract:

Ｏｂｊｅｃｔｉｖｅ：To establish a new mode of double filtration plasmapheresis (DFPP) combining centrifugal/membranous plasma separation techniques, and to evaluate its efficacy, safety and advantages compared with the traditional membranous DFPP (MDFPP) through a prospective, nonrandomized controlled study.
Ｍｅｔｈｏｄｏｌｏｇｙ：Patients requiring DFPP treatment were screened for enrollment. They received DFPP due to renal diseases associated with antineutrophil cytoplasmic antibody (ANCA) or antiglomerular basement membrane (GBM) antibody. After enrollment, patients who already had central venous catheter and had no contraindications for adequate systemic anticoagulant were assigned to receive MDFPP, and the others were assigned to receive centrifuge/membrane hybrid DFPP (C/Mhybrid DFPP). For MDFPP, plasma was separated by a plasma separator MPS07, and passed through a fractional plasma separator EC20W for a second filtration; while for C/Mhybrid DFPP, plasma was separated by a centrifugal apheresis system and was secondly filtrated through a EC20W filter, which was the same as in MDFPP. For one session of DFPP, up to 15 fold of the total plasma volume was processed, with a supplement of 35~45g human albumin.
Ｒｅｓｕｌｔｓ：32 patients (15 males) were divided into 14 in MDFPP and 18 in C/Mhybrid DFPP. A total of 79 sessions of DFPP were performed, with 27 sessions of MDFPP and 52 sessions of C/Mhybrid DFPP. There was no significant difference between MDFPP and C/Mhybrid DFPP in the regards of reduction ratio of IgG，IgA, IgM, as well as the amount of supplemented human albumin, reduction ratio of serum albumin and  platelets counts [(905%±1189%) vs (1700%±1491%)，P=0114]. While for the reduction ratio of the titer of autoimmune antibodies, C/Mhybrid DFPP was higher than MDFPP[(3678%±1644%) vs. 2562%±1167%), P=0043]. The blood flow rate in MDFPP was significantly higher than that in C/Mhybrid DFPP [(11821±868) ml/min vs. (3529±414) ml/min, P＜0001]. The dosage of LMWH in C/Mhybrid DFPP was much lower than that in MDFPP. C/Mhybrid DFPP did not increase the incidence of adverse reactions.
Ｃｏｎｃｌｕｓｉｏｎ：Compared with MDFPP, C/M-hybrid DFPP had not only some apparent technical superiorities including lower requirements of blood flow rate and systemic anticoagulation, but also higher efficacy for removal of pathogenic autoimmune antibodies. Besides to these, its effect on platelet count was similar with MDFPP, and avoided the technical complications associated with MDFPP like hemolysis.