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Safety of High-Volume Plasmapheresis in Children With Acute Liver Failure
Marianne Hørby Jørgensen1, Allan Rasmussen2, Vibeke Brix Christensen1
1Department of Paediatric and Adolescent Medicine.
Insights
High-volume plasmapheresis (HVP) is a safe and feasible treatment for pediatric acute liver failure (P-ALF). This study found HVP well-tolerated in children, with no serious adverse events or procedure-related mortality observed.
Area of Science:
- Hepatology
- Pediatric Critical Care
- Plasma Exchange
Background:
- Pediatric acute liver failure (P-ALF) is a rare, high-mortality condition requiring supportive care and toxin removal.
- High-volume plasmapheresis (HVP) is effective in adult ALF, but its use in children is not well-established.
Purpose of the Study:
- To evaluate the safety and feasibility of high-volume plasmapheresis (HVP) in pediatric acute liver failure (P-ALF).
Main Methods:
- Retrospective analysis of 16 children with P-ALF treated with HVP between 2012-2019.
- HVP involved fresh frozen plasma (10% body weight) for at least 3 consecutive days, indicated by high bilirubin or toxic hepatitis.
- Data collected included diagnostics, clinical/biochemical parameters during HVP, and 3-month outcomes.
Main Results:
- Sixteen children underwent HVP, with 10 surviving (8 without transplant, 2 post-transplant).
- The only complication was transient alkalosis (pH > 7.55) in 3 children, easily corrected.
- No bleeding, septic episodes, or procedure-related mortality occurred.
Conclusions:
- High-volume plasmapheresis (HVP) using fresh frozen plasma is feasible and well-tolerated in pediatric acute liver failure.
- HVP demonstrated a favorable safety profile in this pediatric cohort, with no serious adverse events.
- The study supports HVP as a viable therapeutic option for children with P-ALF.
Objectives:
Paediatric acute liver failure (P-ALF) is a rare condition and is associated with a high mortality rate. Management of P-ALF aims to stabilise vital organ functions and to remove circulating toxins and provide vital plasma factors that are lacking. High-volume plasmapheresis (HVP) removes protein-bound substances and improves survival in adult ALF. It is unknown if this effect can be extrapolated to P-ALF. The aim of this study is to report the safety and feasibility of HVP in P-ALF.
Methods:
Children with P-ALF were offered HVP if bilirubin was higher than 200 μmol/L or if the aetiology was toxic hepatitis. HVP was performed with fresh frozen plasma corresponding to 10% of the body weight on a minimum of 3 consecutive days. Diagnostics, biochemical and clinical data during HVP as well as outcome data after 3 months were collected from 2012 to 2019 and retrospectively analysed.
Results:
Sixteen children were treated by HVP and completed at least one series of three treatment sessions with HVP. The only complication seen was an increase in pH > 7.55 in three children within the first 12 hours and was corrected with hydrochloric acid. No bleeding or septic episodes were noted during HVP. Eight children survived without liver transplantation, two survived after successful grafting and a total of six children died. The liver injury unit score between survivors with their own liver and the rest, the two groups was significantly different (P = 0.005).
Conclusion:
HVP with fresh frozen plasma is feasible and well tolerated in children with P-ALF. No serious adverse events and no procedure-related mortality were observed.
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