High volume plasma exchange in fulminant hepatic failure

Area of Science:

• Hepatology
• Transplantation Medicine
• Critical Care Medicine

Background:

• Fulminant hepatic failure (FHF) presents a critical medical emergency with high mortality.
• Encephalopathy, particularly at stages 3 or 4, indicates severe neurological compromise in FHF.
• Limited effective treatments exist for FHF, often necessitating liver transplantation.

Purpose of the Study:

• To evaluate the efficacy of repeated high-volume plasma exchange (PE) with fresh donor plasma in patients with FHF.
• To assess the impact of PE on survival and clinical stability in FHF patients.
• To determine the potential role of PE as a bridge to liver transplantation.

Main Methods:

• Eleven patients with FHF, all in stage 3 or 4 encephalopathy, underwent repeated high-volume plasma exchange.
• The intended protocol was a daily exchange of extracellular volume (20% body weight) for three consecutive days.
• An average of 2.6 exchanges were performed, with a mean volume of 16% body weight per exchange.

Main Results:

• Five out of eleven patients (46%) survived the treatment, with all survivors having acetaminophen-induced liver failure.
• Four of the six non-survivors experienced temporary improvements in cerebral function, with two achieving complete wakefulness.
• Non-survivors remained clinically stable (systolic blood pressure > 110 mm Hg) for a mean of 6.9 days post-PE initiation.

Conclusions:

• Plasma exchange with fresh donor plasma may be a viable option for acute liver failure patients with residual liver function.
• PE can potentially stabilize patients with definite liver failure, improving their condition until liver transplantation.
• This therapeutic approach warrants consideration in the management of severe acute liver failure.