In a hospital-based cohort of 506 TPE sessions, adverse event rates in patients 75+ were statistically indistinguishable from patients under 75 — 43.4% vs. 40.6% of sessions (p = 0.592) — even though the older group carried significantly more hypertension and cardiac disease. The one notable difference: asymptomatic hypocalcemia was more common in older patients, while allergic reactions were more common in younger ones.
A study published in the Journal of Clinical Apheresis in 2026 is the first to specifically evaluate TPE tolerability using a 75-and-over age threshold — the definition most commonly used for "elderly" in Western clinical practice.Coirier 2026 Earlier studies on age and TPE tolerance used a lower cutoff of 65. The results are reassuring on their face, but the patient population studied is meaningfully different from an outpatient longevity setting, and that context matters for how the findings should be used. Here's what the study actually shows.
What the Study Found
Coirier and colleagues ran a single-center retrospective case-control study at Rennes University Hospital (France), covering TPE sessions performed between 2011 and 2023.
Patients aged 75 and older accounted for only 7.4% of all TPE sessions during that period — 31 elderly patients were identified and matched 1:1 by indication with 31 patients under 75, for a combined 506 TPE sessions (249 in the elderly group, 257 in the control group).
| Characteristic | Under 75 (N=31) | 75+ (N=31) | p-value |
|---|---|---|---|
| Hypertension | 9.7% | 58.1% | <0.001 |
| Cardiac disease | 3.2% | 29.0% | 0.012 |
| Dialysis catheter used | 45.2% | 74.2% | 0.038 |
| Median TPE sessions | 5 | 4 | 0.676 |
Source: Coirier et al., Journal of Clinical Apheresis 2026;41:e70155.
Despite this significantly higher comorbidity and dialysis-catheter-use burden in the older group, overall adverse event rates were not significantly different between groups — 40.6% of sessions in younger patients vs. 43.4% in older patients (p = 0.592). One-year survival was also statistically comparable: 83.9% in younger patients vs. 74.2% in older patients (p = 0.307).
Who These Patients Actually Were
This is the context that matters most for interpreting the study, and it's worth being direct about it: this was not an outpatient longevity or wellness population. It was a hospital-referred cohort being treated for serious autoimmune, hematologic, and neurologic disease.
The leading indications in the elderly group were peripheral neuropathy (53.8% of elderly sessions), thrombotic microangiopathy, Guillain-Barré syndrome, and myasthenia gravis. Nearly three-quarters of elderly patients (74.2%) required a dialysis catheter for vascular access, and fresh frozen plasma was used as replacement fluid in roughly a quarter of elderly sessions — a modality profile that reflects acute hospital-based apheresis, not the albumin-based outpatient protocols typical of a longevity clinic setting.
That distinction cuts in a specific direction: this was, if anything, a sicker and more comorbid elderly population than most outpatient longevity patients would present as. The fact that TPE was well tolerated here — in patients with significantly more hypertension, cardiac disease, and complex hospital-level indications — is reassuring background evidence for the broader principle that age alone is not a contraindication to TPE. It is not direct evidence about outcomes in a healthier, self-selected outpatient population, which has not been separately studied.
The Complications, Compared
Overall complication rates were comparable — but two specific adverse events broke in opposite directions by age.
| Complication | Under 75 | 75+ | p-value |
|---|---|---|---|
| All complications | 40.6% | 43.4% | 0.592 |
| Hypotension (any) | 16.4% | 21.7% | 0.162 |
| Asymptomatic hypocalcemia | 10.5% | 17.3% | 0.040 |
| Allergic reaction | 5.1% | 1.2% | 0.020 |
| Venous access complication | 8.6% | 10.4% | 0.578 |
Source: Coirier et al., Journal of Clinical Apheresis 2026;41:e70155.
Hypotension was the most common complication in both groups and trended higher in older patients, but the difference did not reach statistical significance, and the vast majority (93%) of hypotension episodes in both groups were asymptomatic. Older patients did show a statistically greater drop in systolic blood pressure during sessions, but the authors note this was not clinically meaningful and did not change how any session was managed.
Asymptomatic hypocalcemia was the one adverse event that was significantly more common in older patients (17.3% vs. 10.5% of sessions, p = 0.04). The authors could not fully explain the difference from replacement-fluid choice alone and suggest it points toward closer calcium monitoring in older patients as a reasonable precaution.
Allergic reactions ran in the opposite direction — more common in younger patients (5.1% vs. 1.2%, p = 0.02) — which is consistent with the general pattern that immune reactivity to plasma-derived products tends to be more pronounced earlier in life.
What This Study Does and Doesn't Establish
What is established: In a hospital-based population with significantly higher rates of hypertension and cardiac disease, patients aged 75+ tolerated TPE at rates statistically comparable to younger patients, with no significant difference in overall adverse events or one-year survival. This is the first study to test that comparison using a 75-year threshold specifically, rather than the more commonly used 65-year cutoff.
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Avinity Health's PlasmaRestore™ protocol is overseen by Dr. Leslie F. Thomas — a Mayo Clinic-trained nephrologist with 20+ years of clinical TPE experience. Candidacy is reviewed individually before any treatment recommendation.
The Bottom Line
The one departure from prior literature worth flagging: earlier studies using a 65-year cutoff have occasionally reported higher one-year mortality in older TPE patients driven by underlying disease. This study did not find that pattern at the 75-year threshold, though the authors attribute the difference partly to limited statistical power rather than claiming it as a firm finding.
For patients considering TPE, the practical implication is this: age by itself is not a disqualifying factor, but appropriate candidacy screening — reviewing comorbidities, medications, and individual risk factors — remains the standard of care regardless of age.