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HVP improves liver transplant-free survival for acute liver failure

In a prospective study, researchers found high-volume plasma exchange increased the odds of survival without liver transplantation among patients with acute liver failure, according to published findings.

Patients with acute liver failure (ALF; n = 182) were randomly assigned a regimen of standard medical therapy (SMT; n = 90) or SMT plus high-volume plasma (HVP; n = 92) exchange for three days. Forty-six of the patients who received HVP and 49% in the SMT alone group underwent LT. Of these, 26.1% in the HVP group underwent LT compared with 35.6% in the SMT alone group.

The primary endpoint of the study was liver transplantation-free survival during hospitalization, with secondary-endpoints including survival after LT with or without HVP with intention-to-treat analysis.

“We hypothesized that HVP would reduce mortality in patients with ALF by attenuating the development of [multiorgan failure],” the researchers wrote.

Overall, the hospital survival rate was higher among patients treated with HVP (58.7%) compared with those who received SMT alone (47.8%; HR = 0.56; 95% CI, 0.36-0.86). Among patients who underwent LT, HVP prior to LT did not improve survival compared with patients who received SMT alone (P = .75), according to the research.

Over the course of the study, systemic inflammatory response syndrome score and sequential organ failure assessment score decreased in patients treated with HVP compared with the SMT only group (P < .001).

Severe adverse events observed between the groups included cardiac arrhythmia, pancreatitis and worsening gas exchange, and were not significantly different between the groups.

“HVP improves clinical and paraclinical variables and increases liver transplant-free survival in patients with ALF,” the researchers concluded. “Based upon our subsequent proof-of-concept study, we suggest that the effect of HVP is mediated by dampening circulating innate immune responses.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.