Growing Evidence for Survival Benefit with Plasma Exchange to Treat Liver Failure

Ashish Goel; Uday Zachariah; Dolly Daniel; Chundamannil E Eapen

doi:10.1016/j.jceh.2023.06.002

Growing Evidence for Survival Benefit with Plasma Exchange to Treat Liver Failure

J Clin Exp Hepatol. 2023 Nov-Dec;13(6):1061-1073. doi: 10.1016/j.jceh.2023.06.002. Epub 2023 Jun 14.

Authors

Ashish Goel¹, Uday Zachariah¹, Dolly Daniel¹, Chundamannil E Eapen¹

Affiliation

¹ Departments of Hepatology and Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India.

PMID: 37975044
PMCID: PMC10643514 (available on 2024-11-01)
DOI: 10.1016/j.jceh.2023.06.002

Abstract

Plasma exchange (PLEX) to treat liver failure patients is gaining increasing momentum in recent years. Most reports have used PLEX to treat patients with acute liver failure (ALF) or acute on chronic liver failure (ACLF). Etiology of liver disease has an important bearing on the prognosis of the illness in these patients. The accruing data suggest survival benefit with PLEX compared with standard medical treatment to treat ALF and ACLF patients, in randomised controlled trials done world-over. The American College of Apheresis now recommends high-volume PLEX as first-line treatment for ALF patients. Most matched cohort studies done from India which recruited patients with a specific etiology of ALF or ACLF report survival benefit with PLEX compared to standard medical treatment. The survival benefit with PLEX appears more pronounced in ALF patients rather than in ACLF patients. Systematic analysis of the efficacy of PLEX to treat ALF and ACLF patients is needed. There is also a need to identify dynamic predictive scores to assess which patients with ALF or ACLF will respond to PLEX.

Keywords: artificial liver support; extracorporeal; plasmapheresis.

Publication types

Review