Short-term survival advantage after plasma exchange in the treatment of acute on chronic liver failure or acute liver failure

Abstract Background: Severe alcoholic hepatitis (SAH) presenting as acute-on-chronic liver failure (ACLF) carries a high short-term mortality. Alteration of gut microbiota is a crucial component implicated in its pathogenesis, whose modulation has been suggested as a potential therapeutic tool. We evaluated the safety of fecal microbiota transplantation (FMT) and its efficacy in improving short-term survival and clinical severity scores in patients with SAH-ACLF.Methods: Thirty-three patients [13 in the FMT arm;20 in the standard of care arm (SOC] with SAH-ACLF were included in this open-label study. A single FMT session was administered as a freshly prepared stool suspension from pre-identified healthy family member stool donors through a nasojejunal tube. Patients were followed up on days seven, twenty-eight, and ninety. Results: Survival at twenty-eight and ninety days was significantly better in the FMT arm (100% versus 60%, P=0.01; 53.84% versus 25%, P=0.02). Hepatic encephalopathy resolved in 100% versus 57.14% (FMT versus SOC, P=0.11) patients, while ascites resolved in 100% versus 40% survivors (P=0.04). Major adverse event rates, including spontaneous bacterial peritonitis and gastrointestinal bleeding, were similar in both groups (P=0.77; P=0.70). Median IL1beta decreased by21.39% (IQR -73.67-7.63) in the FMT group, whereas it increased in the SOC by 27.44% (IQR -0.88-128.11) (P=0.01). Percentage changes in bilirubin and ALT between baseline and day seven emerged as predictors of ninety-day mortality.Conclusion: FMT is safe, improves short-term and medium-term survival, and leads to improvement in clinical severity scores in patients with SAH-ACLF.

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TLR-10 Single Nucleotide Polymorphism is Associated to Poor Short Term Survival in Cirrhotic Patients with Acute on Chronic Liver Failure Precipitated by Bacterial Infections

Journal of Hepatology ◽

10.1016/s0168-8278(16)00335-4 ◽

2016 ◽

Vol 64 (2) ◽

pp. S279-S280

Author(s):

P. Caraceni ◽

M. Domenicali ◽

M. Baldassarre ◽

F.A. Giannone ◽

E. Marasco ◽

...

Keyword(s):

Single Nucleotide Polymorphism ◽

Liver Failure ◽

Bacterial Infections ◽

Nucleotide Polymorphism ◽

Chronic Liver Failure ◽

Short Term ◽

Term Survival ◽

Single Nucleotide ◽

Cirrhotic Patients ◽

Short Term Survival

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Recognition and Early Management of Acute Liver Failure

Acute Medicine Journal ◽

10.52964/amja.0109 ◽

2005 ◽

Vol 4 (3) ◽

pp. 92-98

Author(s):

Philip Berry ◽

◽

Julia Wendon ◽

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

The Body ◽

Neurological Injury ◽

Definitive Treatment ◽

Next Of Kin ◽

Short Term ◽

Term Survival ◽

Early Management ◽

Short Term Survival

Acute liver failure (ALF) is a rare but frequently devastating condition, with the potential to disable virtually every organ and system in the body. However, if it is recognised swiftly, and if its specific complications are managed actively, a good outcome can be achieved, especially in the young. The first hours are crucial in stabilising the patient, optimising metabolic and cardiovascular parameters, and reducing the risk of permanent neurological injury or brain death. Simultaneous liason with a specialist unit will allow a planned, safe transfer and access to definitive treatment such as liver transplantation, should the patient require it. This review highlights the clinical and laboratory features of ALF, emphasises aspects of early treatment which will aid short term survival, and makes recommendations concerning safe transfer to a liver unit. Information is also given to aid early counselling of relatives and next of kin.

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Comparison of plasma exchange, double plasma molecular adsorption system, and their combination in treating acute-on-chronic liver failure

Journal of International Medical Research ◽

10.1177/0300060520932053 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052093205

Author(s):

Xiju Guo ◽

Fengqing Wu ◽

Weibo Guo ◽

Jiachang Zhang ◽

Yan Yang ◽

...

Keyword(s):

Liver Failure ◽

Plasma Exchange ◽

Combined Treatment ◽

Chronic Liver ◽

Molecular Adsorption ◽

Adsorption System ◽

Chronic Liver Failure ◽

Short Term ◽

Physical Treatment ◽

Cell Counts

Objective Our objective was to compare the effectiveness of nonbiological artificial liver (NBAL) support, particularly short-term (28-day) survival rates, in patients who underwent treatment using double plasma molecular adsorption system (DPMAS), plasma exchange (PE), or combined PE+DPMAS, in addition to comprehensive physical treatment for different stages of acute-on-chronic liver failure (ACLF). Methods We retrospectively reviewed clinical data of 135 patients with ACLF who received NBAL treatment between November 2015 and February 2019. The patients were categorized into PE, DPMAS, and PE+DPMAS groups. Short-term effectiveness of treatment was assessed and compared based on selected clinical findings, laboratory parameters, and liver function markers. Results Coagulation function improved significantly in all groups after treatment. In the PE and PE+DPMAS groups, prothrombin time decreased to different degrees, whereas plasma thromboplastin antecedent increased significantly after treatment. White blood cell counts increased and platelet counts decreased in all groups after treatment. The model for end-stage liver disease score, Child–Pugh grade, systematic inflammatory syndrome score, and sepsis-related organ failure score decreased in all three groups after treatment. Conclusions PE, DPMAS, and PE+DPMAS improved disease indicators in all patients with ACLF. The combined treatment improved the short-term effectiveness of treatment, especially in patients with mild ACLF.

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