Study to Evaluate Safety and Efficacy of LifeLiver in Acute or Acute-on-Chronic Liver Failure Patients

Background: Patients with acute-on-chronic liver failure (ACLF) might be at risk for citrate accumulation during plasma adsorption plus plasma exchange (PE) therapy with regional citrate anticoagulation (RCA). Objectives: To assess the safety and efficacy of RCA during double plasma molecular adsorption system (DPMAS) plus PE therapy for patients with ACLF. Method: A prospective nonrandomized controlled pilot study was conducted at West China Hospital of Sichuan University. Patients with ACLF were enrolled to heparin anticoagulation (HA) group and RCA group. Serial blood samples were taken. Patients were followed up for 3 months. Results: Twenty-four patients with 94 sessions of HA and 28 patients with 106 sessions of RCA were enrolled. RCA method did not affect the therapeutic efficacy, the function of extracorporeal circulation, and the prognosis of these patients. The occurrences of citrate accumulation in RCA group were 0.0, 67.0, 100.0, 34.0, and 0.0% before DPMAS therapy, at the end of DPMAS therapy, immediately after PE therapy, 2 h after PE therapy, and the next morning, while that in HA group were 0.0, 0.0, 100.0, 7.4, and 0.0%, respectively. The occurrences of citrate accumulation at the end of DPMAS therapy and at 2 h after PE therapy in RCA group were much higher than that in HA group (67.0 vs. 0.0%, p = 0.000; 34.0 vs. 7.4%, p = 0.000, respectively). Although the trend of citrate accumulation in RCA group was much more obvious than that in HA group during and after DPMAS plus PE therapy (p = 0.000), the values on the next morning were similar between the 2 groups (p > 0.05). The main alteration of acid–base status was metabolic alkalosis with no difference between the 2 groups. Conclusions: RCA might be safe and effective in patients with ACLF receiving plasma adsorption plus PE therapy. RCA method might offer an alternative anticoagulation method for them.

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Safety And Efficacy of Terlipressin In Acute-On-Chronic Liver Failure With Acute Kidney Injury – A Prospective Cohort Study

10.21203/rs.3.rs-1068465/v1 ◽

2021 ◽

Author(s):

Anand V. Kulkarni ◽

Sowmya T.R ◽

Harshvardhan Tevethia ◽

Madhumita Premkumar ◽

Karan Kumar ◽

...

Keyword(s):

Acute Kidney Injury ◽

Adverse Events ◽

Liver Failure ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Safety And Efficacy ◽

Disease Response ◽

Recommended Treatment

Abstract Background: Terlipressin with albumin, the recommended treatment for hepatorenal syndrome-acute kidney injury (HRS-AKI), is associated with adverse events. Furthermore, the course of AKI in patients with acute-on-chronic liver failure (ACLF) is unknown. We aimed to analyze the safety and efficacy of terlipressin infusion and AKI course in patients with ACLF.Methods: We prospectively enrolled consecutive adult patients with ACLF with HRS-AKI (satisfying either EASL or APASL criteria) treated with terlipressin infusion between 14 October 2019 and 24 July 2020. The objectives were to assess the incidence of adverse events, response to terlipressin, and differential treatment response in EASL and APASL subgroups. Results: Of the 116 patients, 51 satisfied EASL criteria, and 65 satisfied APASL criteria. Twenty-one percent of patients developed adverse effects. Only 1/3rd of patients who developed adverse events were alive at day 90. Sixty-five percent of the patients responded to terlipressin. Nearly 22% developed recurrence of HRS, and 5.2% progressed to HRS-chronic kidney disease. Response to terlipressin was higher in EASL (78.43%) than APASL subgroup (53.84%;P=0.006). Terlipressin non-response predicted mortality in EASL (aHR,6.35[1.15-35.13];P=0.03) and APASL subgroups (aHR,3.07[1.47-6.4];P=0.003).Conclusion: ACLF patients who develop terlipressin adverse events have dismal prognoses. Terlipressin non-response predicts mortality in patients with ACLF and HRS-AKI.

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