P067 Outcomes in patients with acute liver failure treated with low volume plasma exchange: UK multicentre experience

Introduction Organ availability remains a barrier to successful management of patients with acute liver failure (ALF). Many patients have contra-indications to transplantation, leaving an ongoing unmet need for alternative and bridging therapies. High volume therapeutic plasma exchange (HV-TPE) has shown promising results in improving survival. In this multi-centre retrospective analysis from the United Kingdom (UK) we present the largest cohort to date of patients undergoing therapeutic plasma exchange (TPE) for the treatment of ALF, using substantially smaller volume exchanges (LV-TPE) than previously studied. Methods Consecutive patients admitted to 5 transplant centre intensive care units (ICU) and receiving TPE treatment for ALF between June 2013- July 2020 were included. Treatment with TPE was based on judgement of the treating clinicians. Clinical and biochemical parameters were recorded on admission and following the final TPE. Outcome measures included changes in the biochemical, physiological and organ function status, overall survival and transplant free survival. Results 120 patients received TPE treatment for ALF. Median age was 38 (30–52) and 59% (n=71) were female. The majority (72.5%) had ALF due to paracetamol overdose and 76.6% of patients met Kings College Criteria (KCC) for poor prognosis. Median number of TPE sessions performed was 3 (IQR 2–3), with a median volume of 4 litres exchanged (IQR 3–5litres). Table 1 shows the changes in clinical variables pre and post TPE. Significant improvements (p <0.05) were seen in the majority of clinical and biochemical variables. Notably there was a reduction in noradrenaline doses (0.4 mcg/kg/min to 0.09mcg/kg/min, p = 0.0001) and in requirements for a second vasopressor agent (29% to 15%, p=0.002). This benefit remained when subgroup analysis of patients fulfilling poor prognostic KCC was performed. Figure 1 shows in those meeting KCC overall survival was 50%. Transplant free survival was 36%; higher than seen in previous cohorts of patients fulfilling KCC and receiving standard medical treatment. Conclusion LV TPE improves clinical variables of patients with ALF comparable with results seen in HV TPE. TPE remains a promising supportive therapy in creating a haemodynamic window of stability for transplant and as an alternative therapy for patients unsuitable for transplantation.