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Therapeutic plasma exchange provides native liver survival benefit in children with acute liver failure: A propensity
Tamoghna Biswas1, Bikrant Bihari Lal1, Vikrant Sood1
1Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Insights
Therapeutic plasma exchange (TPE) significantly improved native liver survival (NLS) and overall survival (OS) in pediatric acute liver failure (PALF) patients. TPE also led to better clinical markers like lower INR and bilirubin levels.
Area of Science:
- Hepatology
- Pediatric Critical Care
- Transfusion Medicine
Background:
- Pediatric acute liver failure (PALF) presents a critical challenge with significant morbidity and mortality.
- Therapeutic plasma exchange (TPE) is a potential treatment modality, but its efficacy in PALF requires robust evaluation.
Purpose of the Study:
- To assess the safety and efficacy of TPE in children diagnosed with PALF.
- To compare native liver survival (NLS) rates between PALF patients treated with TPE and a propensity-matched control group.
Main Methods:
- A cohort of 403 PALF patients was analyzed, with 65 receiving TPE and 65 matched controls selected via propensity score matching.
- Matching criteria included international normalized ratio (INR), hepatic encephalopathy grade, age, bilirubin, and ammonia levels.
- The primary outcome was native liver survival (NLS) at 28 days.
Main Results:
- TPE recipients showed significantly lower INR, bilirubin levels, and higher mean arterial pressure (MAP) on day 4 compared to controls.
- Native liver survival (NLS) was 46.15% in the TPE group versus 26.15% in the control group (P=0.001).
- Overall survival (OS) was 50.8% for TPE and 35.4% for controls; NLS benefit was notable in hepatitis A-related and indeterminate PALF.
Conclusions:
- Therapeutic plasma exchange (TPE) demonstrates improved native liver survival and overall survival in pediatric acute liver failure.
- TPE treatment is associated with favorable biochemical and hemodynamic markers within the first week of therapy.
- The benefits of TPE appear most pronounced in specific etiologies of PALF, such as hepatitis A-related cases.
Objectives:
This study aimed to evaluate the safety and efficacy of therapeutic plasma exchange (TPE) in pediatric acute liver failure (PALF).
Methods:
All children aged 2-18 years with PALF were included. The intervention cohort included a subset of PALF patients undergoing complete three sessions of TPE, whereas the matching controls were derived by propensity score matching from the patient cohort who did not receive any TPE. Propensity matching was performed based on the international normalized ratio (INR), grade of hepatic encephalopathy (HE), age, bilirubin, and ammonia levels. The primary outcome measure was native liver survival (NLS) in the two arms on day 28.
Results:
Of the total cohort of 403 patients with PALF, 65 patients who received TPE and 65 propensity-matched controls were included in analysis. The 2 groups were well balanced with comparable baseline parameters. On day 4, patients in the TPE group had significantly lower INR (P = 0.001), lower bilirubin (P = 0.008), and higher mean arterial pressure (MAP) (P = 0.033) than controls. The NLS was 46.15% in the TPE arm and 26.15% in the control arm. The overall survival (OS) was 50.8% in the TPE arm and 35.4% in the control arm. Kaplan-Meier survival analysis showed a significantly higher NLS in patients receiving TPE than controls (P = 0.001). On subgroup analysis, NLS benefit was predominantly seen in hepatitis A-related and indeterminate PALF.
Conclusion:
TPE improved NLS and OS in a propensity-matched cohort of patients with PALF. Patients receiving TPE had lower INR and bilirubin levels and higher MAP on day 4.
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