A preliminary experience of plasma exchange in liver failure
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 fo...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Asian Journal of Transfusion Science |
| Subjects: | |
| Online Access: | http://www.ajts.org/article.asp?issn=0973-6247;year=2022;volume=16;issue=2;spage=209;epage=213;aulast=Dandu |
| _version_ | 1811200627555958784 |
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| author | Himanshu Dandu Vivek Kumar Amit Goel Dheeraj Khetan Tulika Chandra Vipin Raj Bharti |
| author_facet | Himanshu Dandu Vivek Kumar Amit Goel Dheeraj Khetan Tulika Chandra Vipin Raj Bharti |
| author_sort | Himanshu Dandu |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T02:06:46Z |
| format | Article |
| id | doaj.art-44e749226b604d6c86b474fcd38c17b3 |
| institution | Directory Open Access Journal |
| issn | 0973-6247 1998-3565 |
| language | English |
| last_indexed | 2024-04-12T02:06:46Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Asian Journal of Transfusion Science |
| spelling | doaj.art-44e749226b604d6c86b474fcd38c17b32022-12-22T03:52:30ZengWolters Kluwer Medknow PublicationsAsian Journal of Transfusion Science0973-62471998-35652022-01-0116220921310.4103/ajts.ajts_115_21A preliminary experience of plasma exchange in liver failureHimanshu DanduVivek KumarAmit GoelDheeraj KhetanTulika ChandraVipin Raj BhartiINTRODUCTION: 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.http://www.ajts.org/article.asp?issn=0973-6247;year=2022;volume=16;issue=2;spage=209;epage=213;aulast=Danduacute liver failureacute on chronic liver failureliver assistive deviceplasmapheresis |
| spellingShingle | Himanshu Dandu Vivek Kumar Amit Goel Dheeraj Khetan Tulika Chandra Vipin Raj Bharti A preliminary experience of plasma exchange in liver failure Asian Journal of Transfusion Science acute liver failure acute on chronic liver failure liver assistive device plasmapheresis |
| title | A preliminary experience of plasma exchange in liver failure |
| title_full | A preliminary experience of plasma exchange in liver failure |
| title_fullStr | A preliminary experience of plasma exchange in liver failure |
| title_full_unstemmed | A preliminary experience of plasma exchange in liver failure |
| title_short | A preliminary experience of plasma exchange in liver failure |
| title_sort | preliminary experience of plasma exchange in liver failure |
| topic | acute liver failure acute on chronic liver failure liver assistive device plasmapheresis |
| url | http://www.ajts.org/article.asp?issn=0973-6247;year=2022;volume=16;issue=2;spage=209;epage=213;aulast=Dandu |
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