Peripheral Venous Access for Low-Volume Centrifugal Plasma Exchange to Treat Patients With Liver Disorders

Centrifugal plasma exchange (PLEX), by virtue of low blood flow rates, can be performed via peripheral venous access. This study aims to assess the utilization, safety, and efficiency of low-volume centrifugal plasma exchange via peripheral venous access (P-PLEX) in liver disease patients.

This retrospective cohort study compared patients with liver disease who underwent low-volume centrifugal P-PLEX (2019-2024) with syndrome-matched patients who underwent plasma exchange via central venous access (C-PLEX). Data on PLEX procedure, venous access, and extraction efficiency for molecules of interest were noted.

Of 448 liver disease patients who underwent centrifugal low-volume PLEX, 81 patients (18.1%) who underwent P-PLEX (M: 60; age: 37 [29.5-46.5] years; median, interquartile range) were compared with 81 syndrome-matched patients who underwent C-PLEX (M: 62; age: 37 [29.5-46.5] years; acute-on-chronic liver failure: 44, acute liver injury/acute liver failure: 21, others: 20). Targeted P-PLEX sessions were completed in 67 of 81 (82%). P-PLEX access was mostly 18-G (n = 64/72 for inlet/return) in antecubital fossa. Thirteen of 81 (16%) P-PLEX patients required access change to C-PLEX. Procedure time was longer in P-PLEX group (105 [82.5-120] min) than in the C-PLEX group (75 [60-91.3] min, P value< 0.001) due to lower flow rates in P-PLEX. When controlled for exchange volumes and baseline values, extraction efficiency of bilirubin (P-PLEX: 34.3% [21.2-42.6], C-PLEX: 27.1% [10.3-41.7]; P value: 0.14) and von Willebrand factor antigen (P-PLEX: 36.1% [21.8-46.8], C-PLEX: 45.6% [32.8-58.3]; P value: 0.19) were similar in both groups. PLEX was performed in the ward (in high monitoring area) in majority of patients in the P-PLEX group (73 [90.1%]) and in the high-dependency unit (43 [53.1%]) in the C-PLEX group. Lower line-related complications with P-PLEX (2/81) vis-à-vis C-PLEX (9/81, P-value: 0.03) were noted.

In this report, low-volume centrifugal PLEX to treat liver disease was performed via peripheral venous access in 18% of patients. P-PLEX was done in the ward, with similar efficiency and better line-related safety; however, the PLEX duration was prolonged by 30 min.