Therapeutic Plasma Exchange in Patients With Acute-On-Chronic Liver Failure
- In ICU
- Mon, 28 Apr 2025
Acute-on-chronic liver failure is a serious syndrome characterised by the development of organ failure following an acute hepatic insult and is associated with high short-term mortality rates. Plasma exchange has emerged as a potential treatment option for patients with acute-on-chronic liver failure.
A recent systematic review and meta-analysis aimed to evaluate the efficacy of plasma exchange compared to standard medical therapy in improving survival outcomes among acute-on-chronic liver failure patients across various definitions and aetiologies.
The analysis included 23 studies encompassing 5336 patients (2724 in the plasma exchange group), with four studies being randomised controlled trials. Using the Mantel-Haenszel method within a random-effects model, the primary outcome assessed was 30-day survival. Plasma exchange treatment was associated with a significant reduction in 30-day mortality and 90-day mortality. Further analysis of six studies (1495 patients, including two randomised controlled trials) demonstrated improved one-year survival in the plasma exchange group.
Subgroup analyses showed significant survival benefits with plasma exchange in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure and alcohol-related acute-on-chronic liver failure at 90 days. Additionally, plasma exchange improved three-month survival across different acute-on-chronic liver failure definitions. The most commonly reported adverse effects of plasma exchange were skin rash and allergic reactions, occurring in approximately 14% of patients.
In conclusion, this comprehensive and up-to-date meta-analysis demonstrates that plasma exchange offers significant survival benefits at one, three, and 12 months compared to standard medical therapy in patients with acute-on-chronic liver failure. These findings support the growing role of plasma exchange as an effective therapeutic strategy in the management of acute-on-chronic liver failure.
Source: Liver International
Image Credit: iStock
References:
Kumar SE, Sithamparapillai K, Choudhury AK, Bharadwaj PK, Trebicka J, Karvellas CJ, Arab JP, Premkumar PS, Eapen CE, Goel A. Therapeutic Plasma Exchange in Patients With Acute-On-Chronic Liver Failure Improves Survival-An Updated Meta-Analysis. Liver Int. 2025 May;45(5):e70018.
