Therapeutic plasma exchange provides native liver survival benefit in children with acute liver failure: A propensity score‐matched analysis

• Published in: Journal of clinical apheresis Vol. 39; no. 3; pp. e22130 - n/a
• Main Authors: Biswas, Tamoghna, Lal, Bikrant Bihari, Sood, Vikrant, Ashritha, Avalareddy, Maheshwari, Ashish, Bajpai, Meenu, Kumar, Guresh, Khanna, Rajeev, Alam, Seema
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.06.2024; Wiley Subscription Services, Inc
• Subjects: Adolescent; Apheresis; Bilirubin - blood; Child; Child, Preschool; children; Female; Hepatic Encephalopathy - therapy; hepatitis A; high‐volume plasma exchange; Humans; International Normalized Ratio; Liver; Liver Failure, Acute - mortality; Liver Failure, Acute - therapy; liver transplantation; Male; pediatric acute liver failure; Plasma Exchange - methods; plasmapheresis; Propensity Score; Retrospective Studies; survival; Survival analysis; Treatment Outcome; high‐volume plasma exchange; hepatitis A; children; plasmapheresis; survival; pediatric acute liver failure; liver transplantation
• ISSN: 0733-2459; 1098-1101; 1098-1101
• DOI: 10.1002/jca.22130

Objectives This study aimed to evaluate the safety and efficacy of therapeutic plasma exchange (TPE) in pediatric acute liver failure (PALF). Methods All children aged 2‐18 years with PALF were included. The intervention cohort included a subset of PALF patients undergoing complete three sessions of TPE, whereas the matching controls were derived by propensity score matching from the patient cohort who did not receive any TPE. Propensity matching was performed based on the international normalized ratio (INR), grade of hepatic encephalopathy (HE), age, bilirubin, and ammonia levels. The primary outcome measure was native liver survival (NLS) in the two arms on day 28. Results Of the total cohort of 403 patients with PALF, 65 patients who received TPE and 65 propensity‐matched controls were included in analysis. The 2 groups were well balanced with comparable baseline parameters. On day 4, patients in the TPE group had significantly lower INR (P = 0.001), lower bilirubin (P = 0.008), and higher mean arterial pressure (MAP) (P = 0.033) than controls. The NLS was 46.15% in the TPE arm and 26.15% in the control arm. The overall survival (OS) was 50.8% in the TPE arm and 35.4% in the control arm. Kaplan‐Meier survival analysis showed a significantly higher NLS in patients receiving TPE than controls (P = 0.001). On subgroup analysis, NLS benefit was predominantly seen in hepatitis A‐related and indeterminate PALF. Conclusion TPE improved NLS and OS in a propensity‐matched cohort of patients with PALF. Patients receiving TPE had lower INR and bilirubin levels and higher MAP on day 4.