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Early Response to Therapeutic Plasma Exchange as a Prognostic Indicator in Pediatric Liver Transplant Recipients with

Ibrahim Bingol1, Tonguc Utku Yilmaz2, Ozge Umur1

  • 1Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.

Pediatric Transplantation
|July 6, 2026
PubMed

Insights

Early response to therapeutic plasma exchange (TPE) within 72 hours significantly predicts survival in pediatric liver transplant recipients experiencing early allograft dysfunction (EAD). This finding offers a crucial prognostic tool for managing these high-risk patients.

Area of Science:

  • Pediatric Hepatology
  • Transplantation Immunology
  • Critical Care Medicine

Background:

  • Early allograft dysfunction (EAD) significantly increases morbidity and mortality post-pediatric liver transplantation.
  • Limited pediatric-specific data exist on the efficacy of therapeutic plasma exchange (TPE) as supportive care for EAD.
  • This study investigates the predictive value of early TPE response on survival in pediatric liver transplant recipients with EAD.

Purpose of the Study:

  • To determine if early response to TPE predicts survival in pediatric liver transplant recipients with EAD.
  • To identify potential early markers for predicting TPE response and patient outcomes.
  • To provide evidence supporting the use of TPE in pediatric liver transplantation.

Main Methods:

  • Retrospective analysis of 15 pediatric patients (0-18 years) with EAD post-living donor liver transplantation who received TPE (2015-2023).
  • EAD diagnosed using Olthoff criteria; TPE response assessed within 72 hours using predefined criteria.
  • Patients categorized into responders (n=9) and non-responders (n=6).

Main Results:

  • Responders demonstrated significant improvements in total bilirubin, INR, AST, and ALT (p<0.004).
  • In-hospital mortality was exclusively observed in non-responders (83.3% vs. 0%, p=0.001).
  • Kaplan-Meier analysis showed significant survival divergence (100% vs. 16.7% at day 45, p=0.0005); lower pre-TPE albumin predicted non-response (p=0.013).

Conclusions:

  • Early TPE response within 72 hours is a strong predictor of survival in pediatric EAD.
  • TPE response can serve as a practical prognostic tool for guiding clinical management.
  • Prospective multicenter studies are recommended to validate these findings.
Abstract

Keywords:
early allograft dysfunctionliver transplantationpediatricprognosissurvivaltherapeutic plasma exchange

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