Is the addition of Plasma Exchange to CRRT Really Beneficial in Acute Liver Failure: A Retrospective Observational Study

OBJECTIVES: Acute liver failure (ALF) is a critical condition often requiring advanced therapies. This study compared the survival outcomes of continuous renal replacement therapy (CRRT) versus CRRT plus plasma exchange (PLEX) in ALF patients with and without liver transplantation.(1–3) METHODS: A retrospective observational study was conducted on 222 ALF patients at Gleneagles Global Hospital, Mumbai. Patients with yellow phosphorus poisoning and Wilson's disease (n=34) were excluded. Propensity score matching, based on peak SOFA scores, yielded 99 patients (CRRT or CRRT plus PLEX) for analysis. Data was obtained from medical records, and survival rates were the primary outcome, stratified by liver transplantation status.(4–6) RESULTS: Among 32 patients undergoing liver transplantation (all KCC-positive), survival rates were significantly higher in the CRRT group compared to the CRRT plus PLEX group (100% vs. 70.6%, p=0.046), despite lower pre-transplant MELD scores in the latter group (31.8 vs. 41.4, p=0.02). In non-transplanted patients, survival rates between CRRT and CRRT plus PLEX were 30.6% and 16.1%, respectively (p=0.251). Among KCC-negative patients in this group, survival was 52.6% (CRRT) versus 37.5% (CRRT plus PLEX), while for KCC-positive patients, survival was 5.9% versus 8.7%. Admission MELD scores were not independently associated with outcomes, and no differences were observed in ICU or hospital stay durations between groups.(7–9) CONCLUSIONS: The study suggests no benefit and potential harm from PLEX in ALF due to etiologies other than yellow phosphorus poisoning or Wilson's disease. PLEX may adversely affect survival, particularly in living donor liver transplant recipients. Further research is warranted to explore these findings.