Exploring role of therapeutic plasma exchange for hepatitis A-related acute liver failure: An Indian multi-center...

Plasma exchange (PLEX) improves survival in acute liver failure (ALF); however, there is no study specifically analyzing its utility in hepatitis A virus-related ALF (HAV-ALF). A few reports suggest that ALF patients who are not on inotropes tolerate PLEX better. We aimed at comparing the efficacy of PLEX and of standard medical treatment (SMT) to treat HAV-ALF.

We retrospectively compared consecutive HAV-ALF patients treated with PLEX (2018-2024) vs. SMT (2011-2024) at 13 centers across India. We compared in-hospital native liver survival in both groups. In the subset of patients not on inotropes, we compared survival and assessed predictors of poor outcome in PLEX and SMT groups.

Eighty-four HAV-ALF patients in PLEX group (61 males; age = 23.5 [21-33] years, median [IQR]; King's College Criteria [KCC] fulfilled = 22 patients, 26.2%) and 150 HAV-ALF in SMT group (101 males; 24 [19-32.3] years; KCC fulfilled = 16, 10.7%) were studied. Overall survival was comparable in PLEX (70.2%) and SMT groups (65.3%) (p-value = 0.47). In a sub-group of hemodynamically stable patients not on inotropes, univariate analysis showed better survival in PLEX group (52/54, 96.3%) as compared to SMT group (81/104, 77.9%; OR = 0.135, 95% CI = 0.03-0.6; p-value = 0.002). However, this benefit was not noted in propensity score matched/regression analyses.

While PLEX did not influence in-hospital outcome across all HAV-ALF patients, it may confer survival benefit in a sub-group who remained hemodynamically stable not requiring inotropes. Studies with larger patient numbers are needed to explore this hypothesis.