Goel Ashish, Zachariah Uday, Daniel Dolly, Eapen Chundamannil E
Departments of Hepatology and Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India.
J Clin Exp Hepatol. 2023 Nov-Dec;13(6):1061-1073. doi: 10.1016/j.jceh.2023.06.002. Epub 2023 Jun 14.
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.
近年来，血浆置换（PLEX）用于治疗肝衰竭患者的应用越来越广泛。大多数报告都使用PLEX治疗急性肝衰竭（ALF）或慢加急性肝衰竭（ACLF）患者。肝病病因对这些患者的疾病预后有重要影响。在全球范围内进行的随机对照试验中，不断积累的数据表明，与标准药物治疗相比，PLEX治疗ALF和ACLF患者具有生存获益。美国单采学会现在推荐大容量PLEX作为ALF患者的一线治疗方法。印度进行的大多数匹配队列研究招募了具有特定ALF或ACLF病因的患者，结果显示与标准药物治疗相比，PLEX具有生存获益。PLEX的生存获益在ALF患者中似乎比在ACLF患者中更为明显。需要对PLEX治疗ALF和ACLF患者的疗效进行系统分析。还需要确定动态预测评分，以评估哪些ALF或ACLF患者对PLEX有反应。
