Abstract
We aims to assess the efficacy and safety of therapeutic plasma exchange (TPE) in pediatric acute liver failure (PALF) and to examine possible risk factors for mortality. Similar data are limited in PALF. Thirty-three cases diagnosed with PALF who received TPE from June 2011 to June 2021 in the pediatric intensive care unit (PICU) of the First Hospital of Jilin University were included in this retrospective cohort analysis. Descriptive statistics were used for the clinical features of these patients and TPE related variables. The effect of TPE was measured by the difference tests before and after treatment. Survivors with native livers and nonsurvivors were also compared by the difference tests. In the TPE combined with continuous renal replacement therapy (CRRT) group (21/33, 63.6%), the patients were older, and more patients had multiple organ dysfunction syndrome (76.2% vs 25%, P =0.009) and a greater need for mechanical ventilation (86.2% vs 8.3%, P ＜0.001). TPE can significantly reduce alanine aminotransferase, total bilirubin, and international normalized ratio . The most common complication in the overall population was hypocalcemia (n=12, 36%), while the most common complication in children under 2 years of age was hypotension (n=3, 40%). The mortality of liver transplant-free patients was 10/30 (30%). The nonsurvivor group had significantly more failed organs, longer PICU stays and more patients requiring ventilatory support. ConclusionsTPE alone or combined with CRRT can effectively improve liver function and may reduce mortality. TPE can be performed relatively safely in critically ill children, including younger patients.
Therapeutic plasma exchange in children with acute liver failure: assessment of laboratory parameters
