Does plasma exchange improve survival in patients with acute liver failure?

The use of therapeutic plasma exchange (PEX) in the management of acute liver failure (ALF) results in better haemodynamic parameters but offers no survival benefit, reports a study.

“PEX is now frequently used in the management of patients with ALF in the UK,” the investigators said. “It is associated with significant improvement in haemodynamic parameters but not survival benefit.” 

A total of 378 patients with ALF (median age 36 years, 64 percent female) were included in the analysis. Of these, 120 received PEX.

PEX led to significant improvements in most clinical variables, including median dose of noradrenaline (reduction from 0.35 to 0.16 μg/kg/min; p=0.001). However, no significant differences were observed in overall survival (51.4 percent vs 62.6 percent; p=0.12) or transplant-free survival (42.6 percent vs 53.1 percent; p=0.24) between patients who received PEX treatment and those on standard medical therapy.

"This real-world study demonstrates significant improvement in haemodynamic status but has not confirmed the survival benefit seen in previous published literature,” the investigators said. “These results should help guide the future use of plasma exchange in this patient population.” 

In this multicentre retrospective cohort study, consecutive patients with ALF who were admitted to seven tertiary liver transplant centres in the UK between June 2013 and December 2021 were included. 

A team of investigators examined the changes in clinical variables following PEX treatment and compared overall and transplant-free survival up to hospital discharge between patients receiving PEX and those receiving standard medical therapy. They also performed propensity score matching to control for intergroup covariates and selection bias.