S2735 Therapeutic Low Volume Plasma Exchange in ALF and ACLF: A Retrospective Single-Centre Study on Clinical Outcomes and Survival

Introduction: Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) are distinct hepatic emergencies with high mortality. ALF occurs in the absence of pre-existing cirrhosis and presents with coagulopathy and encephalopathy. ACLF, in contrast, is superimposed on chronic liver disease and often involves systemic inflammation and multiorgan failure. Therapeutic plasma exchange (PLEX) is increasingly being used to mitigate systemic toxicity and inflammation in both conditions. This study assesses the impact of low-volume PLEX ± CRRT on liver severity scores and outcomes in patients with ALF and ACLF. Methods: It's a retrospective analysis conducted at a single tertiary centre from January 2022 to March 2025, involving 15 patients—10 with ALF and 5 with ACLF—who underwent 2 to 4 sessions of PLEX. Three patients also received CRRT due to renal dysfunction. ALFED and MELD scores (for ALF), and CLIF-SOFA and MELD scores (for ACLF) were compared before and after treatment. Outcomes and demographic details were recorded. Results: In the ALF group (mean age: 22.8 years; 6 men, 4 women), 80% of patients survived while 20% succumbed to the illness. Notably, both ALFED score and MELD showed a significant decrease post-treatment (change in ALFED - 3.2 ± 2.658, P-value = 0.004), (change in MELD - 8.4 ± 11.087, P-value = 0.040). Among the ACLF cohort (mean age: 38.4 years; 3 men, 2 women), 3 patients (60%) showed clinical improvement and were discharged, whereas 2 patients died (40%). There was no significant difference in pre and post CLIF SOFA score (change- 3, P-value = 0.662). MELD scores also showed no significant decrease (change- 7.2 ± 10.663, P-value = 0.206). Conclusion: PLEX shows encouraging results in ALF, with marked improvements in clinical severity scores and survival, suggesting its potential as a valuable supportive therapy. In ACLF, although short-term stabilization was observed, the overall benefit appeared limited. Further prospective, larger-scale studies are needed to better define the role of PLEX in the management of ALF and ACLF.