Science and Research

Therapeutic plasma exchange in acute on chronic liver failure

BACKGROUND: Acute on chronic liver failure (ACLF) has been identified as a distinct syndrome due to acute decompensation of liver cirrhosis accompanied by extra-hepatic organ failure, primarily caused by an overwhelming systemic immune response. Therapeutic plasma exchange (TPE) has been demonstrated in a randomized controlled trial to improve transplant free survival in acute liver failure. Here we investigated if TPE might have comparable beneficial effects in patients with ACLF. METHODS: Thirty-one patients with ACLF that were treated with TPE were enrolled into this retrospective analysis and 1:1 matched to an ACLF cohort treated with standard medical therapy (SMT) only. RESULTS: Patients considered for a bridge to recovery (n = 21 each group) approach had a 30-day mortality >90% that was not improved by TPE (P = .185). Deaths occurred in the SMT group at significant earlier time points compared to the patients treated with TPE (mortality at 5 days: 33.3% for TPE and 66.7% for SMT, P = .048). However, patients who received TPE as a bridge to transplant strategy (n = 10) survived in 60% of cases and demonstrated 24 hours after study inclusion a stabilization of organ dysfunction (organ failures at inclusion: 4 (3-5) vs 24 hours after inclusion: 3 (2-4), P = .031 and CLIF-C-ACLF score: 64 (49-76) vs 54 (49-66), P = .043) not seen in SMT patients. CONCLUSIONS: Although these retrospective data need to be interpreted with caution, they suggest that TPE in ACLF patients is feasible but not suitable as a bridge to recovery strategy. In selected patients TPE might assist as bridge to transplant.

  • Stahl, K.
  • Busch, M.
  • Fuge, J.
  • Schneider, A.
  • Manns, M. P.
  • Seeliger, B.
  • Schmidt, J. J.
  • Wiesner, O.
  • Schmidt, B. M. W.
  • Taubert, R.
  • Vondran, F. W. R.
  • Hoeper, M. M.
  • David, S.

Keywords

  • decompensation of liver cirrhosis
  • liver transplantation
  • plasmapheresis
Publication details
DOI: 10.1002/jca.21799
Journal: J Clin Apher
Pages: 316-327 
Number: 4
Work Type: Original
Location: BREATH
Disease Area: ROR
Partner / Member: MHH
Access-Number: 32583446
See publication on PubMed

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