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• W2272563886 abstract "The mortality of patients with acute liver failure (ALF) remains high, despite advances in supportive management and bridging to liver transplantation. Disappointingly, prospective trials of extracorporeal support with albumin dialysis, superflux dialyzers in series with absorption columns, and bioartificial devices containing hepatocytes have not demonstrated a significant survival advantage. In the era before liver failure became an established treatment for ALF, there were case series reports of plasma exchange improving cardiovascular stability, extending survival, to allow liver transplantation and increasing overall survival. Larsen and colleagues now report on a randomized, three-center, prospective controlled trial of plasma exchange in a wide range of patients presenting with ALF who had grade 2 encephalopathy or greater. This trial took 12 years to recruit 183 patients. Although there have been advances in supportive care over time, the investigators reported no differences in outcomes when comparing earlier and later recruitment. Compared with many previous studies, the patients were randomized to high-volume plasma exchange, 15% of ideal body weight or around 10–12 liters of fresh-frozen plasma per session for 3 consecutive days. Not all patients received 3 days of treatment because of early death or transplantation. Some patients started plasma exchange therapy shorty after intensive care admission, whereas others had treatment initiation delayed for more than 48 hours. Despite these confounders, the authors reported not only improved cardiovascular stability but also improved patient survival, particularly for those patients who did not receive transplants, and in particular for patients with severe illness who qualified for transplant listing but could not be listed because of contraindications for transplantation. The question arises of why higher-volume plasma exchange should be beneficial. The authors examined removal of markers of cell death (damage-associated molecular pattern molecules) and innate immune system activity in a small cohort of patients, but it remains unclear whether the benefits of high-volume plasma exchange are due to the removal of toxins or the addition of fresh-frozen plasma. Thus, this study will promote further investigation of the effects of plasma exchange. Andrew Davenport" @default.
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• W2272563886 date "2015-12-01" @default.
• W2272563886 modified "2023-10-02" @default.
• W2272563886 title "High-volume plasma exchange in patients with acute liver failure: an open randomized controlled trial" @default.
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• W2272563886 doi "https://doi.org/10.1038/ki.2015.338" @default.
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