• Fin Stolze Larsen, Lars Ebbe Schmidt, Christine Bernsmeier, Allan Rasmussen, Helena Isoniemi, Vishal C Patel, Evangelos Triantafyllou, William Bernal, Georg Auzinger, Debbie Shawcross, Martin Eefsen, Peter Nissen Bjerring, Jens Otto Clemmesen, Krister Hockerstedt, Hans-Jørgen Frederiksen, Bent Adel Hansen, Charalambos G Antoniades, and Julia Wendon.
• Department of Hepatology, Rigshospitalet, Copenhagen, Denmark. Electronic address: stolze@post3.tele.dk.
• J. Hepatol. 2016 Jan 1; 64 (1): 69-78.

Background & AimsAcute liver failure (ALF) often results in cardiovascular instability, renal failure, brain oedema and death either due to irreversible shock, cerebral herniation or development of multiple organ failure. High-volume plasma exchange (HVP), defined as exchange of 8-12 or 15% of ideal body weight with fresh frozen plasma in case series improves systemic, cerebral and splanchnic parameters.MethodsIn this prospective, randomised, controlled, multicentre trial we randomly assigned 182 patients with ALF to receive either standard medical therapy (SMT; 90 patients) or SMT plus HVP for three days (92 patients). The baseline characteristics of the groups were similar. The primary endpoint was liver transplantation-free survival during hospital stay. Secondary-endpoints included survival after liver transplantation with or without HVP with intention-to-treat analysis. A proof-of-principle study evaluating the effect of HVP on the immune cell function was also undertaken.ResultsFor the entire patient population, overall hospital survival was 58.7% for patients treated with HVP vs. 47.8% for the control group (hazard ratio (HR), with stratification for liver transplantation: 0.56; 95% confidence interval (CI), 0.36-0.86; p=0.0083). HVP prior to transplantation did not improve survival compared with patients who received SMT alone (CI 0.37 to 3.98; p=0.75). The incidence of severe adverse events was similar in the two groups. Systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores fell in the treated group compared to control group, over the study period (p<0.001).ConclusionsTreatment with HVP improves outcome in patients with ALF by increasing liver transplant-free survival. This is attributable to attenuation of innate immune activation and amelioration of multi-organ dysfunction.Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

23 keywords...

hide…