PMID- 36065827
OWN - NLM
STAT- MEDLINE
DCOM- 20221202
LR  - 20221202
IS  - 1098-1101 (Electronic)
IS  - 0733-2459 (Linking)
VI  - 37
IP  - 6
DP  - 2022 Dec
TI  - Therapeutic plasma exchange is a safe and effective bridge therapy in patients 
      with alcohol-associated ACLF not having immediate prospects for liver 
      transplantation-A case-control, pilot study.
PG  - 553-562
LID - 10.1002/jca.22010 [doi]
AB  - BACKGROUND: Therapeutic plasma exchange (TPE) is a well-established treatment 
      modality in acute liver failure patients, but its efficacy in treating acute on 
      chronic liver failure (ACLF) patients is yet to be established. AIM: To assess 
      the efficacy and safety of TPE in patients with alcohol-associated ACLF who were 
      nonresponders to standard medical treatment (SMT) and without immediate prospects 
      for liver transplantation. METHODS: Twenty-eight alcohol-related ACLF (grade II) 
      patients (14 cases and 14 controls) were enrolled in the study. Cases underwent 
      standard volume TPE along with SMT while the controls were on SMT alone. The 
      change (baseline to day 10) in laboratory parameters, cytokine concentrations, 
      clinical severity scores along with 30 and 90 day mortality rates were noted and 
      compared between the two groups. The adverse events (AEs) were noted in the 
      groups and analyzed. RESULTS: A total of 51 TPE procedures were performed in 14 
      patients (average of 3.62 procedures/patient). TPE was effective in reduction of 
      serum bilirubin, ammonia, activated partial thromboplastin time, prothrombin 
      time, international normalized ratio, and severity scores (ACLF Research 
      Consortium, Maddrey's discriminant function, and model for end-stage liver 
      disease) (P < .05). There was no significant difference in the reduction of serum 
      interleukin-6 (IL-6), IL-10, and tumor necrosis factor-alpha concentrations among 
      cases. Among the cases who received the complete TPE interventions, 30- and 
      90-day mortality rates were lower in the cases as compared to controls albeit 
      only the 90-day mortality was significantly different. Procedure-related AEs was 
      observed in 2% of procedures. CONCLUSION: TPE is an effective and well-tolerated 
      bridge therapy in patients with alcohol-associated ACLF of moderate severity not 
      improving on SMT and without immediate prospects for liver transplantation.
CI  - (c) 2022 Wiley Periodicals LLC.
FAU - Ramakrishnan, Sharanya
AU  - Ramakrishnan S
AUID- ORCID: 0000-0002-6533-9182
AD  - Department of Transfusion Medicine, Post Graduate Institute of Medical Education 
      and Research (PGIMER), Chandigarh, India.
FAU - Hans, Rekha
AU  - Hans R
AUID- ORCID: 0000-0001-7101-0853
AD  - Department of Transfusion Medicine, Post Graduate Institute of Medical Education 
      and Research (PGIMER), Chandigarh, India.
FAU - Duseja, Ajay
AU  - Duseja A
AUID- ORCID: 0000-0003-3590-2664
AD  - Department of Hepatology, Post Graduate Institute of Medical Education and 
      Research (PGIMER), Chandigarh, India.
FAU - Sharma, Ratti Ram
AU  - Sharma RR
AD  - Department of Transfusion Medicine, Post Graduate Institute of Medical Education 
      and Research (PGIMER), Chandigarh, India.
LA  - eng
PT  - Journal Article
DEP - 20220906
PL  - United States
TA  - J Clin Apher
JT  - Journal of clinical apheresis
JID - 8216305
SB  - IM
MH  - Humans
MH  - *Acute-On-Chronic Liver Failure/therapy
MH  - Plasma Exchange/methods
MH  - Pilot Projects
MH  - *Liver Transplantation
MH  - *End Stage Liver Disease/therapy
MH  - Severity of Illness Index
MH  - Case-Control Studies
OTO - NOTNLM
OT  - APASL
OT  - alcohol-associated liver disease
OT  - alcoholic hepatitis
OT  - cirrhosis
OT  - plasma exchange
EDAT- 2022/09/07 06:00
MHDA- 2022/12/03 06:00
CRDT- 2022/09/06 05:12
PHST- 2022/01/08 00:00 [revised]
PHST- 2021/06/20 00:00 [received]
PHST- 2022/08/19 00:00 [accepted]
PHST- 2022/09/07 06:00 [pubmed]
PHST- 2022/12/03 06:00 [medline]
PHST- 2022/09/06 05:12 [entrez]
AID - 10.1002/jca.22010 [doi]
PST - ppublish
SO  - J Clin Apher. 2022 Dec;37(6):553-562. doi: 10.1002/jca.22010. Epub 2022 Sep 6.