Centrifugal Versus Membrane-Based Therapeutic Plasma Exchange in Pediatric Seronegative Neuroimmune Disorders: Neurologic Outcome and Age Specific Safety Profile.

BACKGROUND

This study evaluated the effectiveness of therapeutic plasma exchange (TPE) modalities in seronegative pediatric neuroimmune disorders, focusing on acute therapy response, 6-month neurological outcomes, and age-stratified adverse events.

METHODS

Retrospective observational cohort between 2018 and 2024. Neurological outcomes were assessed at five predetermined set points during 6 months.

RESULTS

Forty-six children underwent 304 TPE procedures in 49 sessions. Early favorable recovery were 84% for autoimmune-encephalitis, 75% for CNS-demyelinating-disorders, 83.3% for Guillan-Barre-syndrome, 66.7% of Juvenile-Myasthenia-Gravis cases. Six-months neurological outcome showed similar recovery rates irrespective-of-TPE-modality used (F[4169] = 0.53, p = 0.711; F[4470] = 0.69, p = 0.602 for CNS and PNS disorders). Adverse events occurred in 20.1% of TPE sessions, were largely age-dependent rather than disease-category or modality-driven, with a 0.891-fold reduction in the likelihood of AE occurrence for each-year increment (OR = 0.891, 95% CI: 0.825-0.962, p = 0.003).

CONCLUSION

Centrifugal and membrane-based TPE are associated with good neurological recovery in seronegative pediatric neuroimmune disorders. Patient age, rather than apheresis modality or disease subtype, has emerged as the primary determinant of the adverse event profile.