Plasma exchange for acute on chronic liver failure: is there a light at the end of the tunnel?

Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus‐infected acute‐on‐chronic liver failure treated by entercavir: A prospective study

“…1 Cirrhosis was diagnosed according to medical history, physical examination, laboratory tests, and in combination with ultrasonography or computed tomography (CT). 15 Exclusion criteria were: (1) co-infection with hepatitis A, C, D, E virus(HAV, HCV, HDV, HEV), or human immunodeficiency virus (HIV); (2) alcohol ingestion within 6 months; (3) uncontrolled diabetes or hypertension; (4) chronic heart, lung or kidney diseases; (5) malignancy including liver cancer; (6) age below 18 or above 65 years old; (7) past history of organ transplantation; (8) switching from TPE to DPMAS due to plasma shortage or allergy. Thus, 60 patients with HBV-ACLF were enrolled and prospectively studied in this study.…”

“…6 Artificial liver support system (ALSS) was first adopted to treat acute liver failure (ALF) in 1970 s with the concept to replace the detoxification functions of the liver. 7 It can provide temporary removal of an array of toxic substances and create an internal environment conducive to liver regeneration, bridging the failing liver to recovery or LT. 8 During the last decades, many types of ALSSs, including therapeutic plasma exchange (TPE), hemoperfusion, continuous hemodiafiltration, molecular absorbents recirculating system (MARS) and fractionated plasma separation, absorption and dialysis system (FPSA), have been developed and applied to the treatment of liver failure. 9 TPE is an extracorporeal procedure that involves separation of toxic plasma from the blood and replacement of equivalent amounts of fresh frozen plasma (FFP) and fluid.…”

A prognostic model for hepatitis B acute‐on‐chronic liver failure patients treated using a plasma exchange‐centered liver support system

“…Several studies have shown that ALSSs, in particular plasma exchange (PE), prolong the survival of patients with both ALF and ACLF . In addition to rapid elimination of toxic metabolites, PE is also able to replenish beneficial plasma factors, which serves as a bridge to LT by providing a suitable environment for liver recovery …”

Metoprolol-induced Severe Liver Injury and Successful Management with Therapeutic Plasma Exchange

“…We chose plasmapheresis as a treatment modality considering the fact that the auto-antibody was positive and the patient was progressively developing overt hepatic encephalopathy. Plasma exchange has been shown to be useful in the treatment of autoimmune diseases and management of hepatic encephalopathy; it acts by decreasing levels of proinflammatory cytokine storm, toxic endogenous anticoagulants, and end products of oxidative stress, as well as improving anti-inflammatory responses [8-10]. There is very little data supporting the role of therapeutic plasmapheresis in the treatment of DILI.…”