Plasma Exchange in Acute and Acute on Chronic Liver Failure

2021 ◽  
Author(s):  
Rakhi Maiwall ◽  
Shiv K. Sarin
Keyword(s):  
Liver Failure ◽  
Plasma Exchange ◽  
High Volume ◽  
Chronic Liver ◽  
Toxic Substances ◽  
Chronic Liver Failure ◽  
Liver Support ◽  
Basic Premise ◽  
Extracorporeal Blood Purification ◽  
Purification Technique

AbstractLiver failure in the context of acute (ALF) and acute on chronic liver failure (ACLF) is associated with high mortality in the absence of a liver transplant. For decades, therapeutic plasma exchange (TPE) is performed for the management of immune-mediated diseases. TPE has emerged as an attractive extracorporeal blood purification technique in patients with ALF and ACLF. The basic premise of using TPE is to remove the toxic substances which would allow recovery of native liver functions by facilitating liver regeneration. In recent years, encouraging data have emerged, suggesting the benefits of TPE in patients with liver failure. TPE has emerged as an attractive liver support device for the failing liver until liver transplantation or clinical recovery. The data in patients with ALF suggest routine use of high-volume TPE, while the data for such a strategy are less robust for patients with ACLF.

scholarly journals Probit-analysis for assessing the effectiveness of various treatment methods for chronic liver failure

2014 ◽  
Vol 95 (3) ◽  
pp. 348-351
Author(s):  
D E Kutepov
Keyword(s):  
Liver Failure ◽  
Plasma Exchange ◽  
Conventional Treatment ◽  
High Volume ◽  
Probit Analysis ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Treatment Methods ◽  
Molecular Adsorbent Recirculating System ◽  
Molecular Adsorbent

Aim. To estimate the validity of probit-analysis for assessing the effectiveness of various treatment methods for chronic liver failure. Methods. The study included 292 patients with chronic liver failure. All patients were distributed to four groups, conventional treatment was performed in all patients. Patients of the 2nd group were additionally administered plasma exchange, of the 3rd group - plasma exchange and high volume continuous veno-venous hemofiltration, of the 4th - molecular adsorbent recirculating system (MARS). To determine the medium lethal time (time at which 50% of patients pass away, ТL50), probit-analysis based on studying the association between the time logarithms and probits corresponding to the observed effects, was used. Results. Standardization of patients’ mortality rate, allowing to exclude biases associated with differences of chronic liver failure severity at admission, was performed. Probit-analysis showed that there were no significant differences in between male and female patients regardless of used treatment methods. ТL50 in patients of any gender treated only by conventional methods was significantly lower compared to other methods of treatment. There was a trend of ТL50 increase in the following sequence: conventional treatment → plasma exchange → plasma exchange and high volume continuous veno-venous hemofiltration → molecular adsorbent recirculating system. Conclusion. Probit-analysis allows to determine the time of 50% mortality (ТL50) in patients with chronic liver failure. Treatment using extracorporeal methods of treatment (plasma exchange, plasma exchange and high volume continuous veno-venous hemofiltration, molecular adsorbent recirculating system) is significantly more effective compared to conventional treatment.

scholarly journals Treatment of patients with chronic liver failure according to disease etiology

2017 ◽  
Vol 98 (1) ◽  
pp. 58-63
Author(s):  
D E Kutepov ◽  
I N Pasechnik
Keyword(s):  
Liver Failure ◽  
Plasma Exchange ◽  
High Volume ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Disease Etiology ◽  
Group 4 ◽  
Molecular Adsorbent Recirculating System ◽  
Group 2 ◽  
Group 1

Aim. Improving the efficiency of treatment of patients with chronic liver failure by optimizing the application of extracorporeal detoxification methods.Methods. The study included 292 patients with chronic liver failure (188 males and 104 females). The main causes of chronic liver failure were nutritional factor (alcohol abuse), viral liver diseases, and the combination of alcoholic and viral factors. All patients regardless of the disease etiology were divided into groups. Patients in group 1 received standard conservative therapy, aimed at relieving the symptoms of chronic liver failure. Patients in group 2 were additionally administered plasma exchange, in group 3 - PE and high-volume venovenous hemofiltration, and in group 4 - sessions of molecular adsorbent recirculating system (MARS).Results. Mortality of patients with chronic liver failure on conservative treatment accounted for 84.0% and was 1.5-2.1 times higher than in other groups (53% in plasma exchange group, 52% when using plasma exchange and high-volume venovenous hemofiltration and 40.6% in MARS group), these differences being statistically significant when compared with group 1 (χ2 from of 18.3 to 23.4, p <0.05). Indicators, reflecting the time of 50% mortality of patients with chronic liver failure of different etiology, suggest that in chronic liver failure of alcoholic origin plasma exchange and a combination of plasma exchange and high-volume venovenous hemofiltration are the most effective, and in chronic liver failure of viral and mixed etiology the best results are obtained when using MARS.Conclusion. The effectiveness of treatment of patients with chronic liver failure depends on the etiology of the disease: in alcoholic chronic liver failure plasma exchange and a combination of plasma exchange and high-volume venovenous hemofiltration are most rational, and in chronic liver failure of viral and mixed etiology MARS sessions are rational.

scholarly journals Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Klementina Ocskay ◽  
Anna Kanjo ◽  
Noémi Gede ◽  
Zsolt Szakács ◽  
Gabriella Pár ◽  
...  
Keyword(s):  
Liver Failure ◽  
Support Systems ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Bioartificial Liver ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Liver Support ◽  
Bioartificial Liver Support ◽  
The Impact

Abstract Background The role of artificial and bioartificial liver support systems in acute-on-chronic liver failure (ACLF) is still controversial. We aimed to perform the first network meta-analysis comparing and ranking different liver support systems and standard medical therapy (SMT) in patients with ACLF. Methods The study protocol was registered with PROSPERO (CRD42020155850). A systematic search was conducted in five databases. We conducted a Bayesian network meta-analysis of randomized controlled trials assessing the effect of artificial or bioartificial liver support systems on survival in patients with ACLF. Ranking was performed by calculating the surface under cumulative ranking (SUCRA) curve values. The RoB2 tool and a modified GRADE approach were used for the assessment of the risk of bias and quality of evidence (QE). Results In the quantitative synthesis 16 trials were included, using MARS®, Prometheus®, ELAD®, plasma exchange (PE) and BioLogic-DT®. Overall (OS) and transplant-free (TFS) survival were assessed at 1 and 3 months. PE significantly improved 3-month OS compared to SMT (RR 0.74, CrI: 0.6–0.94) and ranked first on the cumulative ranking curves for both OS outcomes (SUCRA: 86% at 3 months; 77% at 1 month) and 3-month TFS (SUCRA: 87%) and second after ELAD for 1-month TFS (SUCRA: 76%). Other comparisons did not reach statistical significance. QE was moderate for PE concerning 1-month OS and both TFS outcomes. Other results were of very low certainty. Conclusion PE seems to be the best currently available liver support therapy in ACLF regarding 3-month OS. Based on the low QE, randomized trials are needed to confirm our findings for already existing options and to introduce new devices.

scholarly journals Meta-analysis of individual patient data of albumin dialysis in acute-on-chronic liver failure: focus on treatment intensity

2019 ◽  
Vol 12 ◽  
pp. 175628481987956 ◽  
Author(s):  
Rafael Bañares ◽  
Luis Ibáñez-Samaniego ◽  
Josep María Torner ◽  
Marco Pavesi ◽  
Carmen Olmedo ◽  
...  
Keyword(s):  
Liver Failure ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Chronic Liver ◽  
Treatment Intensity ◽  
Chronic Liver Failure ◽  
Albumin Dialysis ◽  
Liver Support ◽  
Molecular Adsorbent Recirculating System

Background: Acute-on-chronic liver failure (ACLF) is a common complication of cirrhosis characterized by single or multiple organ failures and high short-term mortality. Treatment of ACLF consists of standard medical care (SMC) and organ(s) support. Whether the efficacy of artificial liver support (ALS) depends on the severity of ACLF or on the intensity of this treatment, or both, is unclear. This study aimed to further assess these issues. Methods: We performed an individual patient data meta-analysis assessing the efficacy of Molecular Adsorbent Recirculating System (MARS) in ACLF patients enrolled in prior randomized control trials (RCTs). The meta-analysis was designed to assess the effect of patient severity (ACLF grade) and treatment intensity [low-intensity therapy (LIT), SMC alone or SMC plus ⩽ 4 MARS sessions, high-intensity therapy (HIT), SMC plus > 4 MARS sessions] on mortality. Results: Three RCTs suitable for the meta-analysis ( n = 285, ACLF patients = 165) were identified in a systematic review. SMC plus MARS (irrespective of the number of sessions) did not improve survival compared with SMC alone, neither in the complete population nor in the ACLF patients. Survival, however, was significantly improved in the subgroup of patients receiving HIT both in the entire cohort (10-day survival: 98.6% versus 82.8%, p = 0.001; 30-day survival: 73.9% versus 64.3%, p = 0.032) and within the ACLF patients (10-day survival: 97.8% versus 78.6%, p = 0.001; 30-day survival: 73.3% versus 58.5%, p = 0.041). Remarkably, HIT increased survival independently of ACLF grade. Independent predictors of survival were age, Model for End-Stage Liver Disease (MELD), ACLF grade, number of MARS sessions received, and intensity of MARS therapy. Conclusion: HIT with albumin dialysis may improve survival in patients with ACLF. Appropriate treatment schedules should be determined in future clinical trials.

scholarly journals Therapeutic plasma exchange in children with acute liver failure (ALF): is it time for incorporation into the ALF armamentarium?

2021 ◽  
Author(s):  
Emma C. Alexander ◽  
Akash Deep
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Plasma Exchange ◽  
Controlled Trial ◽  
High Volume ◽  
Systemic Circulation ◽  
Liver Support ◽  
Extracorporeal Liver Support ◽  
Randomised Controlled ◽  
Liver Assist Devices

AbstractPaediatric acute liver failure (PALF) is a rare but devastating condition with high mortality. An exaggerated inflammatory response is now recognised as pivotal in the pathogenesis and prognosis of ALF, with cytokine spill from the liver to systemic circulation implicated in development of multi-organ failure associated with ALF. With advances in medical management, especially critical care, there is an increasing trend towards spontaneous liver regeneration, averting the need for emergency liver transplantation or providing stability to the patient awaiting a graft. Hence, research is ongoing for therapies, including extracorporeal liver support devices, that can bridge patients to transplant or spontaneous liver recovery. Considering the immune-related pathogenesis and inflammatory phenotype of ALF, plasma exchange serves as an ideal liver assist device as it performs both the excretory and synthetic functions of the liver and, in addition, works as an immunomodulatory therapy by suppressing the early innate immune response in ALF. After a recent randomised controlled trial in adults demonstrated a beneficial effect of high-volume plasma exchange on clinical outcomes, this therapy was incorporated in European Association for the Study of Liver (EASL) recommendations for managing adult patients with ALF, but no guidelines exist for PALF. In this review, we discuss rationale, timing, practicalities, and existing evidence regarding the use of plasma exchange as an immunomodulatory treatment in PALF. We discuss controversies in delivery of this therapy as an extracorporeal device, and practicalities of use of plasma exchange as a ‘hybrid’ therapy alongside other extracorporeal liver assist devices, before finally reviewing outstanding research questions for the future.

Review of Methods to Remove Protein-Bound Substances in Liver Failure

2002 ◽  
Vol 25 (10) ◽  
pp. 911-917 ◽  
Author(s):  
R.D. Hughes
Keyword(s):  
Liver Failure ◽  
Plasma Proteins ◽  
High Volume ◽  
Toxic Substances ◽  
Albumin Dialysis ◽  
Liver Support ◽  
Excretory Function ◽  
Bioartificial Liver Support ◽  
Wide Range

A wide range of toxic substances accumulates in the circulation of patients with liver failure, including more lipid-soluble substances, which bind to plasma proteins. Serum albumin is the most important binding protein for ligands such as bilirubin and bile acids, which are potentially toxic and can cause apoptosis in astrocytes and hepatocytes respectively in vitro. Resin haemoperfusion was originally investigated to remove these compounds, as well as inflammatory cytokines. Current effective methods for removal of protein-bound compounds in patients with liver failure include high volume plasmapheresis and different forms of albumin dialysis. Bioartificial liver support systems need adsorbent and/or dialysis modules to replace the lack of excretory function.

Therapeutic plasma exchange in acute on chronic liver failure

2020 ◽  
Vol 35 (4) ◽  
pp. 316-327
Author(s):  
Klaus Stahl ◽  
Markus Busch ◽  
Jan Fuge ◽  
Andrea Schneider ◽  
Michael P. Manns ◽  
...  
Keyword(s):  
Liver Failure ◽  
Plasma Exchange ◽  
Chronic Liver ◽  
Therapeutic Plasma Exchange ◽  
Chronic Liver Failure
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