TY - JOUR
T1 - Therapeutic plasma-exchange improves short-term, but not long-term, outcomes in patients with acute-on-chronic liver failure
T2 - A propensity score-matched analysis
AU - Swaroop, Shekhar
AU - Arora, Umang
AU - Biswas, Sagnik
AU - Vaishnav, Manas
AU - Pathak, Piyush
AU - Agarwal, Ankit
AU - Golla, Rithvik
AU - Thakur, Bhaskar
AU - Coshic, Poonam
AU - Andriyas, Vijay
AU - Gupta, Kamini
AU - Elhence, Anshuman
AU - Nayak, Baibaswat
AU - Kumar, Ramesh
AU - Shalimar,
N1 - Publisher Copyright:
© 2022 Wiley Periodicals LLC.
PY - 2023/8
Y1 - 2023/8
N2 - Background: Acute-on-chronic liver failure (ACLF) is associated with a high short-term mortality rate in the absence of liver transplantation. The role of therapeutic plasma exchange (TPE) in improving the outcomes of ACLF and acute decompensation (AD) is unclear. In this retrospective analysis, we aimed to determine the impact of TPE on mortality in patients with ACLF. Methods: ACLF patients receiving TPE with standard medical treatment (SMT) were propensity score matched (PSM) with those receiving SMT alone (1:1) for sex, grades of ACLF, CLIF C ACLF scores, and the presence of hepatic encephalopathy. The primary outcomes assessed were mortality at 30 and 90 days. Survival analysis was performed using Kaplan Meier survival curves. Results: A total of 1151 patients (ACLF n = 864 [75%], AD [without organ failure] n = 287 [25%]) were included. Of the patients with ACLF (n = 864), grade 1, 2, and 3 ACLF was present in 167 (19.3%), 325 (37.6%), and 372 (43.0%) patients, respectively. Thirty-nine patients received TPE and SMT, and 1112 patients received only SMT. On PSM analysis, there were 38 patients in each group (SMT plus TPE vs SMT alone). In the matched cohort, the 30-days mortality was lower in the TPE arm compared to SMT (21% vs 50%, P =.008), however, the 90-day mortality was not significantly different between the two groups (36.8% vs 52.6%, P =.166); HR, 0.82 (0.44-1.52), P =.549. Conclusion: TPE improves short-term survival in patients with ACLF, but has no significant impact on long-term outcomes. Randomized control trials are needed to obtain a robust conclusion in this regard.
AB - Background: Acute-on-chronic liver failure (ACLF) is associated with a high short-term mortality rate in the absence of liver transplantation. The role of therapeutic plasma exchange (TPE) in improving the outcomes of ACLF and acute decompensation (AD) is unclear. In this retrospective analysis, we aimed to determine the impact of TPE on mortality in patients with ACLF. Methods: ACLF patients receiving TPE with standard medical treatment (SMT) were propensity score matched (PSM) with those receiving SMT alone (1:1) for sex, grades of ACLF, CLIF C ACLF scores, and the presence of hepatic encephalopathy. The primary outcomes assessed were mortality at 30 and 90 days. Survival analysis was performed using Kaplan Meier survival curves. Results: A total of 1151 patients (ACLF n = 864 [75%], AD [without organ failure] n = 287 [25%]) were included. Of the patients with ACLF (n = 864), grade 1, 2, and 3 ACLF was present in 167 (19.3%), 325 (37.6%), and 372 (43.0%) patients, respectively. Thirty-nine patients received TPE and SMT, and 1112 patients received only SMT. On PSM analysis, there were 38 patients in each group (SMT plus TPE vs SMT alone). In the matched cohort, the 30-days mortality was lower in the TPE arm compared to SMT (21% vs 50%, P =.008), however, the 90-day mortality was not significantly different between the two groups (36.8% vs 52.6%, P =.166); HR, 0.82 (0.44-1.52), P =.549. Conclusion: TPE improves short-term survival in patients with ACLF, but has no significant impact on long-term outcomes. Randomized control trials are needed to obtain a robust conclusion in this regard.
KW - cirrhosis
KW - liver failure
KW - liver transplantation
KW - mortality
KW - plasmapheresis
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U2 - 10.1002/jca.22033
DO - 10.1002/jca.22033
M3 - Article
C2 - 36408827
AN - SCOPUS:85142275314
SN - 0733-2459
VL - 38
SP - 376
EP - 389
JO - Journal of Clinical Apheresis
JF - Journal of Clinical Apheresis
IS - 4
ER -