Plasmapheresis in Low Body Weight Infant With Acute Liver Failure

Therapeutic plasma exchange (TPE) is an established treatment modality in the management of acute liver failure, with evidence from multicenter randomized controlled trials demonstrating improved overall survival in affected patients. In this setting, massive hepatic necrosis, release of pro-inflammatory cytokines, and the onset of multi-organ failure driven by a systemic inflammatory response all contribute significantly to mortality. TPE offers potential benefits through the removal of circulating cytokines and toxins, alongside the replacement of critical plasma proteins, including coagulation factors. However, its application in pediatric populations presents unique challenges, particularly in infants with very low body weight. Here, we describe the case of a 6-month-old infant with end-stage liver disease secondary to biliary atresia, in whom TPE was successfully implemented as a bridging strategy to urgent liver transplantation despite profound hepatic dysfunction and a body weight of just 4.9 kg. This case highlights the need for individualized protocol adaptation and careful physiological monitoring to ensure safe and effective apheresis in this patient population.