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Therapeutic Plasma Exchange in Children With Acute and Acuteon-Chronic Liver Failure: A Single-Center Experience
Sadık Kaya1, Neslihan Ekşi Bozbulut
1From the Pediatric Intensive Care Unit, Hatay Research and Education Hospital, Hatay, Turkey.
Insights
Therapeutic plasma exchange shows promise for pediatric acute liver failure. This treatment may help patients recover spontaneously or bridge them to liver transplantation, offering a vital intervention for this critical condition.
Area of Science:
- Pediatric critical care medicine
- Hepatology
- Extracorporeal therapies
Background:
- Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) are life-threatening conditions in children.
- Liver transplantation is often the only definitive treatment for ALF/ACLF.
- Identifying effective bridging therapies is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the efficacy of therapeutic plasma exchange (TPE) in pediatric patients with ALF or ACLF.
- To assess TPE as a bridge to liver transplantation or spontaneous recovery.
- To analyze clinical and laboratory parameters in patients undergoing TPE.
Main Methods:
- Retrospective, single-center study of pediatric patients receiving TPE for ALF/ACLF between April 2020 and December 2021.
- Analysis of clinical data, laboratory findings, and scoring systems (e.g., PRISM III, MELD/PELD).
- Comparison of pre- and post-TPE scores to assess treatment impact.
Main Results:
- Nineteen pediatric patients were included; 13 with ALF and 5 with ACLF.
- Significant improvements were observed in Pediatric Risk of Mortality (PRISM) and Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease (MELD/PELD) scores post-TPE.
- No significant difference in LIU or POG scores between non-survivors and those treated at transplant centers.
Conclusions:
- Therapeutic plasma exchange may serve as a beneficial bridging therapy for pediatric patients with ALF or ACLF.
- TPE can potentially facilitate spontaneous liver recovery or support patients awaiting liver transplantation.
- Further research is warranted to confirm the role of TPE in managing pediatric liver failure.
Objectives:
Acute liver failure is a life-threatening condition that may result in death if liver transplant is not performed. The aim of our study was to evaluate patients with acute liver failure or acute-on-chronic liver failure who were followed and treated with therapeutic plasma exchange in a pediatric intensive care unit until they achieved clinical recovery or underwent liver transplant.
Materials And Methods:
In this retrospective, singlecenter study, we included patients with acute liver failure or acute-on-chronic liver failure who received therapeutic plasma exchange between April 2020 and December 2021. Clinical findings, laboratory findings, extracorporeal therapies, Pediatric Risk of Mortality III and liver injury unit scores and pretherapy and posttherapy hepatic encephalopathy scores, Model for End-Stage Liver Disease score, and Pediatric End-Stage Liver Disease score were retrospectively analyzed.
Results:
Nineteen patients were included in the study. One patient was excluded because of positivity for COVID-19. The mean age of children was 62.06 months, ranging from 5 months to 16 years (12 boys, 6 girls). Thirteen patients (72.2%) had acute liver failure, and 5 patients (27.8%) had acute-on-chronic liver failure. No significant difference was shown for mean liver injury unit score (P = .673) and Pediatric Logistic Organ Dysfunction score (P = .168) between patients who died and patients who received treatment at the inpatient clinic and transplant center. However, Pediatric Risk of Mortality score and the mean Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease scores before therapeutic plasma exchange and after therapeutic plasma exchange (after 3 consecutive days of treatment) were statistically significant (P = .001 and P = .004).
Conclusions:
Therapeutic plasma exchange may assist bridge to liver transplant or assist with spontaneous recovery of liver failure in pediatric patients with acute liver failure or acute-on-chronic liver failure.
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