Back to Search Start Over

Standard-Volume Plasma Exchange Improves Outcomes in Patients With Acute Liver Failure: A Randomized Controlled Trial.

Authors :
Maiwall, Rakhi
Bajpai, Meenu
Singh, Akanksha
Agarwal, Tanvi
Kumar, Guresh
Bharadwaj, Ankit
Nautiyal, Nidhi
Tevethia, Harsh
Jagdish, Rakesh Kumar
Vijayaraghavan, Rajan
Choudhury, Ashok
Mathur, Rajendra Prasad
Hidam, Ashini
Pati, Nirupama Trehan
Sharma, Manoj Kumar
Kumar, Anupam
Sarin, Shiv Kumar
Source :
Clinical Gastroenterology & Hepatology; Apr2022, Vol. 20 Issue 4, pe831-e854, 24p
Publication Year :
2022

Abstract

High volume plasma-exchange (HVPE) improves survival in patients with acute liver failure (ALF), but apprehension regarding volume overload and worsening of cerebral edema remain. In an open-label randomized controlled trial, 40 consecutive patients of ALF were randomized 1:1 to either standard medical treatment (SMT) or SMT with standard-volume plasma-exchange (SVPE). SVPE was performed using centrifugal apheresis [target volume of 1.5 to 2.0 plasma volumes per session] until desired response was achieved. Cerebral edema was assessed by brain imaging. Results were analyzed in an intention-to-treat analysis. Primary outcome was 21-day transplant-free survival. The levels of cytokines, damage-associated molecular patterns (DAMPs) and endotoxins were analyzed at baseline and day 5. ALF patients [aged 31.5 ± 12.2 years, 60% male, 78% viral, 83% hyperacute, 70% with SIRS were included. At day 5, SVPE [mean sessions 2.15 ± 1.42, median plasma volume replaced 5.049 L] compared to SMT alone, resulted in higher lactate clearance (p =.02), amelioration of SIRS (84% vs. 26%; P =.02), reduction in ammonia levels [(221.5 ± 96.9) vs.(439 ± 385.6) μg/dl, P =.02) and SOFA scores [9.9(±3.3) vs. 14.6(±4.8); P =.001]. There were no treatment related deaths. SVPE was associated with a higher 21-day transplant free-survival [75% vs. 45%; P =.04, HR 0.30, 95%CI 0.01-0.88]. A significant decrease in levels of pro-inflammatory cytokines and an increase in anti-inflammatory cytokines along with a decrease in endotoxin and DAMPs was seen with SVPE. In ALF patients with cerebral edema, SVPE is safe and effective and improves survival possibly by a reduction in cytokine storm and ammonia. ClinicalTrial.gov (identifier: NCT02718079) [Display omitted] [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
15423565
Volume :
20
Issue :
4
Database :
Supplemental Index
Journal :
Clinical Gastroenterology & Hepatology
Publication Type :
Academic Journal
Accession number :
155725344
Full Text :
https://doi.org/10.1016/j.cgh.2021.01.036