Burke Laura, Bernal William, Pirani Tasneem, Agarwal Banwari, Jalan Rajiv, Ryan Jennifer, Bangash Mansoor Nawaz, El-Dalil Phillip, Murphy Nick, Donnelly Mhairi, Davidson Janice, Simpson Ken, Giles Hannah, Mone Phyo Set, Masson Steven, Davenport Andrew, Rowe Ian, Moore Joanna
Leeds Liver Unit, Leeds NHS Teaching Hospitals Trust, Leeds, UK; Leeds Institute for Medical Research, University of Leeds, Leeds, UK.
Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK.
J Hepatol. 2025 Apr;82(4):615-621. doi: 10.1016/j.jhep.2024.09.034. Epub 2024 Oct 1.
BACKGROUND & AIMS: Therapeutic plasma exchange (PEX) has emerged as a potential treatment option for patients with acute liver failure (ALF). The effect of PEX on survival outcomes outside of clinical trials is not yet well established. In this study we aimed to evaluate the real-world use and outcomes of PEX for the treatment of ALF.
This multicentre retrospective cohort study included consecutive patients with ALF admitted to all seven tertiary liver transplant centres in the UK between June 2013 and December 2021. Changes in clinical variables following PEX treatment were assessed, while overall survival and transplant-free survival up to hospital discharge in patients receiving PEX were compared to those receiving standard medical therapy Propensity score matching was performed to control for intergroup covariates and selection bias.
We included 378 patients with ALF (median [IQR] age 36 (28-48), 64% [n = 242] female) of whom 120 received PEX. There was a significant improvement in most clinical variables following PEX, including median dose of noradrenaline (reduction from 0.35 μg/kg/min [0.19-0.70 μg/kg/min] to 0.16 μg/kg/min [0.08-0.49], p = 0.001). There was no significant difference between PEX and standard medical therapy groups in overall survival (51.4% vs. 62.6%, respectively, p = 0.12) or transplant-free survival (42.6% vs. 53.1%, p = 0.24).
PEX is now frequently used in the management of patients with ALF in the UK. It is associated with significant improvement in haemodynamic parameters but not survival benefit.
Therapeutic plasma exchange is frequently used in the management of patients with acute liver failure in the UK. This real-world study demonstrates significant improvement in haemodynamic status but has not confirmed the survival benefit seen in previous published literature. These results should help guide the future use of plasma exchange in this patient population.
治疗性血浆置换（PEX）已成为急性肝衰竭（ALF）患者潜在的治疗选择。在临床试验之外，PEX对生存结局的影响尚未完全明确。在本研究中，我们旨在评估PEX治疗ALF的实际应用情况及结局。
这项多中心回顾性队列研究纳入了2013年6月至2021年12月期间英国所有7家三级肝移植中心收治的连续ALF患者。评估PEX治疗后临床变量的变化，同时将接受PEX治疗的患者与接受标准药物治疗的患者直至出院时的总生存率和无移植生存率进行比较。进行倾向评分匹配以控制组间协变量和选择偏倚。
我们纳入了378例ALF患者（年龄中位数[四分位间距]为36岁[28 - 48岁]，64%[n = 242]为女性），其中120例接受了PEX治疗。PEX治疗后，大多数临床变量有显著改善，包括去甲肾上腺素的中位剂量（从0.35μg/kg/分钟[0.19 - 0.70μg/kg/分钟]降至0.16μg/kg/分钟[0.08 - 0.49]，p = 0.001）。PEX组和标准药物治疗组在总生存率（分别为51.4%和62.6%，p = 0.12）或无移植生存率（42.6%和53.1%，p = 0.24）方面无显著差异。
目前在英国，PEX常用于ALF患者的管理。它与血流动力学参数的显著改善相关，但对生存无益处。
治疗性血浆置换在英国常用于急性肝衰竭患者的管理。这项真实世界研究表明血流动力学状态有显著改善，但未证实先前发表文献中所见的生存益处。这些结果应有助于指导该患者群体未来血浆置换的使用。
