Does Therapeutic Plasma Exchange (TPE) improve longevity?

Therapeutic Plasma Exchange Does Not Improve Longevity

Therapeutic Plasma Exchange (TPE) has not been shown to improve overall survival or longevity in general use, and is only recommended for specific medical conditions where it may improve organ-specific outcomes rather than overall mortality. 1

Evidence Against TPE for Longevity

• TPE is primarily used as a therapeutic intervention for specific autoimmune and inflammatory conditions, not as a longevity intervention 1
• In ANCA-associated vasculitis with severe renal disease, TPE improves renal survival but has not been shown to improve overall survival 1
• Recent guidelines from the American College of Rheumatology/Vasculitis Foundation (2021) specifically note that while TPE may decrease the risk of end-stage renal disease in patients with active glomerulonephritis, it showed no difference in mortality (risk ratio 1.15 [95% CI 0.78-1.70]) 1
• TPE is actually associated with a higher risk of severe infection compared to standard therapy (risk ratio 1.19 [95% CI 0.99-1.42]) 1
• In rapidly progressive interstitial lung disease (RP-ILD), guidelines conditionally recommend against plasma exchange as a first-line treatment option 1

Specific Clinical Applications of TPE

Renal Applications

• TPE is recommended only for selected patients with rapidly progressive severe renal disease to improve renal survival, not overall survival 1
• TPE should be considered only for patients at higher risk of progression to end-stage renal disease who can accept the potential increased risk of infection 1

Cardiac Applications

• In heart transplant recipients with severe primary graft dysfunction, TPE has been associated with increased 30-day and 1-year survival rates compared to those who did not receive TPE (78.1% vs. 40% at 30 days, p=0.007) 2
• However, this is a very specific application and does not translate to general longevity benefits 2

Neurological Applications

• TPE is used for certain autoimmune neurological diseases primarily to remove pathogenic autoantibodies, not to extend lifespan 3
• While TPE shows improvement in functionality for conditions like myasthenia gravis, Guillain-Barré syndrome, and neuromyelitis optica spectrum disorders, this represents disease-specific improvement rather than longevity enhancement 3

Potential Risks and Limitations

• TPE can cause significant adverse effects including hypotension and hydroelectrolytic disorders 3
• TPE significantly reduces plasma levels of inflammatory and cardiac biomarkers, which can complicate medical monitoring 4
• In acute liver failure, a real-world cohort study showed that while TPE improved hemodynamic parameters, it did not provide a survival benefit 5
• TPE availability is limited to specialized centers, and the procedure carries significant costs 1

Conclusion for Clinical Practice

• TPE should be reserved for specific medical indications where evidence supports its use for organ-specific outcomes 1
• There is no evidence supporting the use of TPE as an intervention to extend lifespan or improve longevity in otherwise healthy individuals 1
• The risks of TPE, including infection and procedural complications, outweigh any theoretical benefit for longevity purposes 1, 3