Therapeutic plasma‐exchange improves systemic inflammation and survival in acute‐on‐chronic liver failure: A propensity‐score matched study from AARC

• DOI: 10.1111/liv.14806
• Publication Date: 2021-02-06T05:12:41Z
• Authors: Rakhi Maiwall; Meenu Bajpai; Ashok K. Choudhury; Anupam Kumar; Manoj Kumar Sharma; Zhongping Duan; Chen Yu; Jinhua Hu; Hasmik Ghazinian; Qin Ning; Ke Ma; Guan H. Lee; Seng G. Lim; Samir Shah; Chetan Kalal; Abdulkadir Dokmeci; Guresh Kumar; Priyanka Jain; Samba Siva Rao Pa...; Irene Paulson; Vinay Kumar; Shiv K. Sarin
• Keywords: Adult; Inflammation; Male; 0301 basic medicine; 0303 health sciences; 03 medical and health sciences; Plasma Exchange; Acute-On-Chronic Liver Failure; Humans; Female; Middle Aged; Propensity Score; 3. Good health

Abstract Background and Aim Plasma‐exchange (PE) has improved survival in acute liver failure by ameliorating systemic inflammatory response syndrome (SIRS). We evaluated PE compared it to Fractional Plasma Separation Adsorption (FPSA) standard medical treatment (SMT) a large multinational cohort of ACLF patients. Methods Data were prospectively collected from the AARC database analysed. Matching propensity risk score (PRS) was performed. Competing analysis done identify deaths because multiorgan (MOF). In subset 10 patients, we also mechanistic basis PE. Results patients (n = 1866, mean age 44.3 ± 12.3 yrs, 93% males, 65% alcoholics) received either artificial support (ALS) 162); [PE 131), FPSA 31)] or continued on therapy 1704). PRS‐matched 208, [ALS‐119; PE‐94, FPSA‐25)], SMT‐89). ALS therapies associated with significantly higher resolution SIRS (Odd's ratio 9.23,3.42‐24.8), lower delayed development MOF (Hazard 7.1, 4.5‐11.1), liver‐failure‐related as SMT ( P < .05). cleared cytokines, damage‐associated molecular patterns, endotoxin all Responders monocyte phagocytic function mitochondrial respiration increased anti‐inflammatory cytokine interleukin‐1 receptor antagonist (IL‐1RA) non‐responders. lesser adverse effects FPSA. Conclusions improves inflammation lowers ACLF. provides significant benefit over could be preferred modality for