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Therapeutic Plasma Exchange with Continuous Renal Replacement Therapy for Pediatric Acute Liver Failure: A Case

Sirawut Trepatchayakorn1, Nataruks Chaijitraruch1, Voranush Chongsrisawat1

  • 1Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|July 28, 2021
PubMed

Insights

Therapeutic plasma exchange with high-volume continuous renal replacement therapy (TPE + HV-CRRT) shows promise for pediatric acute liver failure (PALF). This supportive treatment improved outcomes, aiding survival and liver recovery in children.

Area of Science:

  • Pediatric critical care medicine
  • Hepatology
  • Extracorporeal therapies

Background:

  • Pediatric acute liver failure (PALF) is a critical condition with limited evidence-based treatment options.
  • Extracorporeal support is utilized for toxic metabolite clearance and as a bridge to liver transplantation (LT) or regeneration.

Observation:

  • A case series reviewed eight PALF patients (9 months to 14 years) treated with TPE + HV-CRRT.
  • Data collected included demographics, indications, technical aspects, and clinical outcomes from January 2016 to September 2019.

Findings:

  • TPE + HV-CRRT improved serum bilirubin and coagulation studies in PALF patients.
  • Complications included hemodynamic instability, fluid overload, and bleeding; 75% of patients survived, with 50% undergoing successful LT and 25% achieving spontaneous recovery.

Implications:

  • TPE + HV-CRRT is a safe bridging therapy for pediatric acute liver failure.
  • Higher TPE volumes or blood flow rates in pediatric patients may correlate with hemodynamic instability, requiring careful monitoring.
Abstract

Keywords:
Acute liver failureDialysis supportsExtracorporeal removalExtracorporeal therapyLiver transplantationPediatric critical carePediatric intensive carePlasma exchangePoisoningTherapeutic Plasma ExchangeYellow phosphorus

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