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Since 1982, we realized 2538 apheresis sessions in 142 different patients. We analyzed the vascular access of these patients. According to the estimate number of sessions we divided this population in 6 groups: group I: less than 5 sessions = femoral vein catheter, group II: subclavian vein catheter less than 5 sessions; group III: 6 to 21 sessions with same catheter, group IV: internal jugular vein catheter (IJVC) for same session number, group V: patients on IJVC undergoins more than 21 session or treated during more than 3 months, group VI long term treated patients with arterio-venous fistula. We analyse the number of patients in each groups, the mean number of session and the absolute number of recorded adverse events such as local of systemic infection, clotting, catheter dysfunction. Results are as follow: [table: see text] Our study shows clearly the advantage of IJVC compared to either subclavian way in middle duration apheresis as in long term when compared to arterio venous fistula.

We report the first known case of a successful pregnancy in a 22-year-old white woman suffering from hepatic Byler's syndrome, a familial fibrogenic cholestasis observed in children and usually leading to death during adolescence or to liver transplantation. A first pregnancy was unsuccessful with intrauterine death. Medical surveillance of the second pregnancy was reinforced due to major cholestasis and itching sensation. Plasmapheresis was employed weekly from the 19th week of gestation. Within 2 weeks of treatment onset, plasma alkaline phosphatase levels returned to normal; pruritus completely disappeared after the second session. Delivery was decided at 33 weeks gestation with uterine section. The female baby weighed 2,090 g and outcome was excellent. This is the first reported case of Byler's syndrome with successful pregnancy. We underline the efficacy and safety of apheresis in this very particular disease.

Since 1983, 28 patients with a rapidly progressive glomerulonephritis were treated with apheresis. Seventeen patients had a primary glomerulonephritis, while 11 had a secondary form. Pathological pattern showed crescentic glomerulonephritis in all cases but one. In 23 cases of 28, renal survival was compromised within a few months. Apheresis were performed with the filtration technique, using a single needle device and central venous catheter. Plasmafilters were reused since 1984. In 1987, cascade filtration was introduced. The procedure was under permanent medical control. Mean reuse rate was 6 time. Renal actuarial survival curve showed a 60%, 42% and 21% survival rate at respectively 1, 2 and 5 years. Five deaths were noted. No death occurred during the apheresis procedure. The mean cost of filters and blood lines was 490 French francs (FF) per session; the mean cost of an haemodialysis session was 1900 FF. When the real survival time was compared to the expected renal failure without apheresis (assuming a linear progression of the disease), patients with a positive response to apheresis saved 488 dialysis months. The amount saved was 12 MFF. The additive cost of inefficient apheresis was 0.06 MFF. These data have to be considered on a 0.5 M inhabitants population basis during a 10 year survey.