Therapeutic plasma exchange in acute liver failure: Unravelling its efficacy and impact

BACKGROUND: Acute liver failure presents a significant medical challenge due to its rapid onset, progression, and high mortality rates, often necessitating liver transplantation. Therapeutic plasma exchange has emerged as a potential intervention to modulate the underlying pathophysiological mechanisms and to reduce the need for immediate transplantation. METHODS: This retrospective monocentric study was conducted at a tertiary referral hospital from June 2023 to March 2024 to assess the efficacy of therapeutic plasma exchange in acute liver failure patients. Clinical parameters, including biochemical markers, coagulation status, and Model for End-Stage Liver Disease scores, were analyzed pre- and post-plasma exchange. Additionally, hospitalization duration and adverse events associated with the procedure were documented. RESULTS: Twenty-five patients with acute liver failure underwent therapeutic plasma exchange resulting in significant improvements in biochemical markers, notably reductions in bilirubin, aspartate transaminase, and alanine transaminase levels (p-value <0.001 for all). Coagulation parameters and Model for End-Stage Liver Disease scores exhibited favorable trends, particularly among discharged patients. Hospitalization duration varied across patient outcomes, indicating the impact of the procedure on clinical course. Adverse reactions were reported but remained manageable, with no severe complications observed. CONCLUSION: Therapeutic plasma exchange demonstrates promising efficacy in stabilizing acute liver failure patients, improving biochemical markers, and potentially mitigating the urgency for immediate transplantation. Despite challenges such as donor scarcity and adverse events, the safety profile remains favorable, suggesting the potential of plasma exchange as a valuable adjunct in acute liver failure management. Further research and clinical scrutiny are warranted to fully ascertain the role of therapeutic plasma exchange in optimizing outcomes.