Value of extracorporeal artificial liver support in pediatric acute liver failure: A single-center experience of over 10 years

Abstract

PurposeAcute liver failure (ALF) is a life-threatening disease characterized by rapid-onset liver dysfunction, coagulopathy, and encephalopathy in patients without chronic liver disease. Today, the combined application of continuous veno-venous hemodiafiltration (CVVHDF) and plasma exchange (PEX), which are forms of supportive extracorporeal therapy (SECT), with conventional liver therapy in ALF is recommended. This study aims to retrospectively analyze the effects of combined SECT in pediatric patients with ALF.Materials and MethodsWe retrospectively analyzed 42 pediatric patients, followed in the liver transplantation intensive care unit. The patients had ALF and received PEX supportive therapy with combined CVVHDF. The biochemical lab values of the results for the patients before the first combined SECT and after the last combined SECT were analyzed comparatively.ResultsOf the pediatric patients included in our study, 20 were girls and 22 were boys. Liver transplantation was performed in 22 patients, and 20 patients recovered without transplantation. After the discontinuation of combined SECT, all patients had significantly lower serum liver function test results (total bilirubin, alanine transaminase, aspartate transaminase), ammonia, and prothrombin time/international normalized ratio levels than the previous levels (p < 0.01). Hemodynamic parameters (i.e., mean arterial pressure) also improved significantly.Discussion and ConclusionCombined CVVHDF and PEX treatment significantly improved biochemical parameters and clinical findings, including encephalopathy, in pediatric patients with ALF. PEX therapy combined with CVVHDF is a proper supportive therapy for bridging or recovery.

Management of pediatric liver failure with therapeutic plasma exchange and continuous renal replacement therapy: A retrospective observational study

“…Hybrid extracorporeal treatments in pediatric liver failure can effectively serve as a bridge to transplantation, playing a crucial role in patient treatment. [13,22]…”

Single-center experience in 127 adult patients, mono or dual artificial liver support therapy, in patients with acute liver failure

“…Recent studies have shown that dual liver support therapies (PE + CRRT) in adult ( 17 – 19 ) and pediatric ( 12 , 15 , 16 , 20 ). ALF patients improve hepatic biochemical parameters, neurological status, and hemodynamic stability.…”

“…We used the protocol published by Ocak ( 15 ) for the indication of mono or dual supportive extracorporeal therapy and liver transplantation. Our apheresis technicians and nurses performed the supportive extracorporeal treatment in our unit in accordance with this protocol.…”

A 15-Year Retrospective Study of Supportive Extracorporeal Therapies Including Plasma Exchange and Continuous Venovenous Hemodiafiltration of 114 Adults with Acute Liver Failure Awaiting Liver Transplantation

“…Patients who received mono-supportive extracorporeal therapy or did not undergo supportive extracorporeal therapy were excluded from the study ( Figure 1 , Table 1 ). The supportive extracorporeal therapy protocol used in our Intensive Care Unit was applied ( Figure 2 ) [ 14 ].…”

“…Our apheresis technicians and nurses performed the supportive extracorporeal therapy application in our unit following this protocol. The algorithm was subsequently published [ 14 ]. The primary aim of this study was to evaluate the efficacy of combined supportive extracorporeal therapy in patients with acute liver failure or acute liver failure who were on the waiting list for liver transplantation.…”