Plasmapheresis in primary dysfunction of hepatic transplants

Area of Science:

• Hepatology
• Transplantation immunology
• Critical care medicine

Background:

• Primary graft dysfunction affects ~5% of liver transplants, often necessitating retransplantation.
• Elevated cytokines (interleukin-6, tumor necrosis factor) are linked to hepatic graft dysfunction.
• Plasmapheresis has historical benefit in fulminant hepatic failure, suggesting potential in graft dysfunction.

Purpose of the Study:

• To evaluate plasmapheresis effectiveness in primary liver graft dysfunction.
• To compare clinical outcomes, patient, and graft survival with historical controls.

Main Methods:

• 18 liver transplant patients with primary graft dysfunction received four daily plasma exchange procedures.
• Outcomes were compared to a historical control group.

Main Results:

• No significant difference in graft survival at 10 days or patient survival at 100 days between groups.
• Plasmapheresis group showed higher dialysis incidence, indicating more severe dysfunction.
• Significant reduction in tumor necrosis factor (66.0%) and interleukin-6 (55.2%) after one procedure.

Conclusions:

• Plasmapheresis did not significantly improve graft survival in primary graft dysfunction.
• A non-significant trend towards increased patient survival was observed in severe cases with renal failure.
• Documented reduction of elevated cytokines (TNF and IL-6) suggests a potential role in managing specific aspects of graft dysfunction.