Asian Journal of Transfusion Science
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Year : 2022  |  Volume : 16  |  Issue : 2  |  Page : 209-213

A preliminary experience of plasma exchange in liver failure

1 Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
3 Department of Gastro-Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
4 Department of Transfusion Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
5 Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India

Correspondence Address:
Dr. Himanshu Dandu
Department of Medicine, King George Medical University, Type 4 77 Old Campus SGPGIMS Rae Bareilly Road, Lucknow - 226 014, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajts.ajts_115_21

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INTRODUCTION: Plasma exchange (PLEX) is one of the experimental modalities of treatment for liver failure. We report our experience of PLEX in patients with acute-(ALF) or acute-on-chronic (ACLF) liver failure. METHODS: Hemodynamically stable adult patients with ALF or ACLF, encephalopathy, model for end-stage liver disease (MELD) score ≥ 15, and clinical worsening/no improvement after 72-h of inpatient care were included. PLEX cycles repeated every 48 h, each of 2.5–4.0 h duration with 1–1.5 times of estimated plasma volume, were given. PLEX cycle was repeated till either of the end-points were achieved (i) MELD < 20 for 48 h or reaches below the baseline, whichever is lower, (ii) completed three PLEX cycles, (iii) hemodynamic instability, (iv) or outcome achieved. Outcome of interest was categorized as favorable (discharged in stable condition) or unfavorable (death or discharge in moribund condition). Data are expressed as median (interquartile range). RESULTS: Sixteen patients (age 35 [27–48] years; male 8; ALF 5, ACLF 11; MELD 33 [27–37]; CLIF-SOFA 10 [8.5–12]) were included. Participants received 2 (1-3) cycles of PLEX during 13 (11–25) days of hospitalization. Overall, serum bilirubin, INR, creatinine, MELD, and CLIF-SOFA scores were significantly improved after PLEX. Five patients (5/16, 31%) had complete resolution of HE. Eight patients (50%) had a favorable outcome. Those with favorable outcome had significant improvement in serum bilirubin, INR, and CLIF-SOFA scores as compared to those with unfavorable outcome. CONCLUSION: PLEX may be effective in patients with ALF or ACLF. More data are needed to establish its role in the management of liver failure.

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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006