Ramakrishnan Sharanya, Hans Rekha, Duseja Ajay, Sharma Ratti Ram
Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
J Clin Apher. 2022 Dec;37(6):553-562. doi: 10.1002/jca.22010. Epub 2022 Sep 6.
Therapeutic plasma exchange (TPE) is a well-established treatment modality in acute liver failure patients, but its efficacy in treating acute on chronic liver failure (ACLF) patients is yet to be established.
To assess the efficacy and safety of TPE in patients with alcohol-associated ACLF who were nonresponders to standard medical treatment (SMT) and without immediate prospects for liver transplantation.
Twenty-eight alcohol-related ACLF (grade II) patients (14 cases and 14 controls) were enrolled in the study. Cases underwent standard volume TPE along with SMT while the controls were on SMT alone. The change (baseline to day 10) in laboratory parameters, cytokine concentrations, clinical severity scores along with 30 and 90 day mortality rates were noted and compared between the two groups. The adverse events (AEs) were noted in the groups and analyzed.
A total of 51 TPE procedures were performed in 14 patients (average of 3.62 procedures/patient). TPE was effective in reduction of serum bilirubin, ammonia, activated partial thromboplastin time, prothrombin time, international normalized ratio, and severity scores (ACLF Research Consortium, Maddrey's discriminant function, and model for end-stage liver disease) (P < .05). There was no significant difference in the reduction of serum interleukin-6 (IL-6), IL-10, and tumor necrosis factor-α concentrations among cases. Among the cases who received the complete TPE interventions, 30- and 90-day mortality rates were lower in the cases as compared to controls albeit only the 90-day mortality was significantly different. Procedure-related AEs was observed in 2% of procedures.
TPE is an effective and well-tolerated bridge therapy in patients with alcohol-associated ACLF of moderate severity not improving on SMT and without immediate prospects for liver transplantation.
治疗性血浆置换（TPE）是急性肝衰竭患者中一种成熟的治疗方式，但其在治疗慢加急性肝衰竭（ACLF）患者中的疗效尚未明确。
评估TPE对酒精相关性ACLF患者的疗效及安全性，这些患者对标准药物治疗（SMT）无反应且无肝移植近期指征。
28例酒精相关性ACLF（II级）患者（14例病例组和14例对照组）纳入本研究。病例组接受标准容量TPE联合SMT，而对照组仅接受SMT。记录并比较两组实验室参数、细胞因子浓度、临床严重程度评分的变化（基线至第10天）以及30天和90天死亡率。记录并分析两组的不良事件（AE）。
14例患者共进行了51次TPE操作（平均每位患者3.62次操作）。TPE有效降低了血清胆红素、氨、活化部分凝血活酶时间、凝血酶原时间、国际标准化比值以及严重程度评分（ACLF研究联盟、马德雷判别函数和终末期肝病模型）（P < 0.05）。病例组血清白细胞介素-6（IL-6）、IL-10和肿瘤坏死因子-α浓度降低无显著差异。在接受完整TPE干预的病例组中，与对照组相比，30天和90天死亡率较低，尽管只有90天死亡率有显著差异。2%的操作观察到与操作相关的AE。
对于酒精相关性中度ACLF患者，TPE是一种有效且耐受性良好的桥接治疗方法，这些患者对SMT无改善且无肝移植近期指征。
