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Therapeutic plasma exchange in liver failure
Abimbola Chris-Olaiya1, Aanchal Kapoor1, Kristin S Ricci2
1Department of Critical Care, Cleveland Clinic, Cleveland, OH 44195, United States.
Therapeutic plasma exchange (TPE) can reduce inflammation and toxins in acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). TPE shows promise in improving survival for patients ineligible for liver transplantation (LT).
Area of Science:
- Hepatology
- Critical Care Medicine
- Immunology
Background:
- Acute-on-chronic liver failure (ACLF) involves multi-organ failure driven by systemic inflammation.
- Limited therapies improve survival in critically ill liver failure patients awaiting or ineligible for liver transplantation (LT).
Purpose of the Study:
- To review the efficacy and technical aspects of therapeutic plasma exchange (TPE) in acute liver failure (ALF) and ACLF.
- To evaluate TPE's role in managing liver failure and as a bridge to LT.
Main Methods:
- Review of existing literature on TPE in ALF and ACLF.
- Analysis of TPE's impact on inflammatory markers, immune modulation, and toxin clearance.
Main Results:
- TPE reduces inflammatory cytokines, modulates immunity, and clears albumin- and water-bound toxins.
- High-volume TPE improved survival and reduced vasopressor needs in ALF patients not eligible for LT.
- Standard TPE reduced mortality in specific ACLF patient subgroups.
Conclusions:
- TPE is an effective therapy for ALF and ACLF, reducing systemic inflammation and improving outcomes.
- TPE shows potential as a bridge to liver transplantation (LT) for ACLF patients.
- Further investigation into TPE's technical considerations and broad application in liver failure is warranted.
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