5. Plasma exchange therapy in patients with ACLF, experience from a tertiary care centre

Abstract

Background and Aims: ACLF prevalence ranges from 24–40% in patients with cirrhosis. Etiology is multifactorial. 28 day mortality in CANONIC study was 22.1%, 32% and 76.7% in AARC grade 1, 2 and 3 respectively. Treatment options for ACLF include liver dialysis and liver transplantation. Methods: Retrospective analysis of 16 patients from April 2017–April 2018. Diagnosis of ACLF was based on APASL criteria. Patient not responding to standard therapy, steroid non responders and steroid ineligible patients were included. PE was given for an average period of 5 days. Patients were followed up for a period of 1month and data was collected at baseline, 7 days post plasma exchange (PPE) and 28 day PPE. Results: Study included 16 patients, of which 15 were male and 1female. Mean age was 50.8 yrs. All patients were diagnosed to have CLD (HBV-2 Alcohol-6 NASH-4 AIH-1 Unknown-3). Acute insult included (HAV-2, HBV reactivation-1, ethanol-5, DILI-7 and unknown-1). Patients were categorized into AARC1-4, AARC2-10 and AARC3-2 according to APASL. 62.5% had hepatic encephalopathy (HE). 31.2% had AKI. Average MELD at baseline was 26.8 and at 7th day PPE was 23. Mortality at day-7 PPE and day-28 PPE was 31.25% and 43.7% respectively. 28 day mortality in AARC 1, AARC 2 and AARC 3 was zero, 50% and 100% respectively. MODS and septicemia contributed significantly to mortality. One patient died of massive upper GI bleed. 28 day and 90 day mortality was 50% and 56.25% respectively. Conclusions: PE did not influence 28 day mortality rate in AARC 2 and AARC 3 subgroup. AARC 1 subgroup showed survival benefits with PE. Larger studies are needed to validate benefits of PE. The authors have none to declare.