Science and Research

Therapeutic plasma exchange in acute liver failure

BACKGROUND: Multi-organ dysfunction in acute liver failure (ALF) has been attributed to a systemic inflammatory response directly triggered by the injured liver. High-volume therapeutic plasma exchange (HV-TPE) has been demonstrated in a large randomized controlled trial to improve survival. Here, we investigated if a more cost-/ resource effective low-volume (LV) TPE strategy might have comparable beneficial effects. METHODS: This retrospective study evaluated the effect of LV-TPE on remote organ failure, hemodynamical and biochemical parameters as well as on survival in patients with ALF. Twenty patients treated with LV-TPE in addition to standard medical therapy (SMT) were identified and 1:1 matched to a historical ALF cohort treated with SMT only. Clinical and biochemical parameters were recorded at admission to the intensive care unit and the following 7 days after LV-TPE. RESULTS: Mean arterial pressure increased following first LV-TPE treatments (d0: 68 [61-75] mm Hg vs d7: 88 [79-98] mm Hg, P = .003) and norepinephrine dose was reduced (d0: 0.264 [0.051-0.906] mug/kg/min vs d3: 0 [0-0.024] mug/kg/min, P = .016). Multi-organ dysfunction was significantly diminished following LV-TPE (CLIF-SOFA d0: 17 [13-20] vs d7: 7 [3-11], P = .001). Thirty-day in-hospital survival was 65% in the LV-TPE cohort and 50% in the SMT cohort (Hazard-ratio for TPE: 0.637; 95% CI: 0.238-1.706, P = .369). CONCLUSIONS: Patients treated with LV-TPE showed improved surrogate parameters comparable with the effects reported with HV-TPE. These data need to be interpreted with caution due to their retrospective character. Future controlled studies are highly desirable.

  • Stahl, K.
  • Hadem, J.
  • Schneider, A.
  • Manns, M. P.
  • Wiesner, O.
  • Schmidt, B. M. W.
  • Hoeper, M. M.
  • Busch, M.
  • David, S.

Keywords

  • Blood Pressure
  • Cost-Benefit Analysis
  • Humans
  • Liver Failure, Acute/complications/mortality/*therapy
  • Multiple Organ Failure/etiology/prevention & control
  • Norepinephrine/therapeutic use
  • Plasma Exchange/economics/*methods
  • Retrospective Studies
  • Survival Analysis
  • acute liver failure
  • liver transplantation
  • plasma exchange
Publication details
DOI: 10.1002/jca.21737
Journal: J Clin Apher
Pages: 589-597 
Number: 5
Work Type: Original
Location: BREATH
Disease Area: General Lung and Other
Partner / Member: MHH
Access-Number: 31348553
See publication on PubMed

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