Related Experiment Video
Updated: Aug 5, 2026
Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
Published on: September 13, 2014
Therapeutic Plasma Exchange for Acute and Acute-on-Chronic Liver Failure: A Randomized Pilot Study Comparing
Amany Sholkamy1, Ahmed Fayed2, Sanaa A Khalil2
1Hepatogastroenterology, Liver ICU, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt.
Background:
Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) carry substantial short-term mortality. While liver transplantation is the definitive therapy, access is often delayed in settings reliant on living-donor transplantation, such as Egypt. Therapeutic plasma exchange (TPE) has emerged as a potential bridging strategy, but evidence from resource-limited health systems remains scarce.
Methods:
We conducted a prospective randomized pilot study including 46 adults with ALF or ACLF at a tertiary center in Egypt. Participants were assigned to standard medical therapy (SMT; n = 15), standard-volume plasma exchange (SVPE; n = 16), or high-volume plasma exchange (HVPE; n = 15). SVPE involved exchange of 1.5-2.0 plasma volumes per session, whereas HVPE delivered 8-12 L/day for 3 consecutive days. All patients received guideline-based SMT. Changes in alanine aminotransferase (ALT), total bilirubin, international normalized ratio (INR), and MELD-Na score were evaluated alongside procedure-related complications and 90-day mortality.
Results:
Both TPE strategies produced greater improvements in ALT, total bilirubin, INR, and MELD-Na compared with SMT alone. HVPE achieved the largest reduction in MELD-Na but was associated with higher rates of catheter-related infection and neurological complications. SVPE demonstrated a more favorable safety-effectiveness profile. Ninety-day mortality was highest with SMT and lower in both TPE groups.
Conclusions:
In a resource-limited tertiary setting, protocolized TPE is feasible and may improve short-term outcomes in ALF and ACLF. SVPE may represent a safer and more scalable bridging strategy when immediate access to liver transplantation is limited.
