Outcome of Patients with Acute on Chronic Liver Failure Undergoing Plasmapheresis-An Observational Study

Background and Aim: Acute on chronic liver failure (ACLF) is a syndrome with high mortality and has few treatment options. Challenges of doing liver transplant are sick patient condition and scarcity of donor. This study aims to investigate the potential benefit of plasmapheresis in ACLF patients without transplant. Methods: This prospective study was conducted at Sir Ganga Ram Hospital. We enrolled 72 patients with ACLF (EASL CLIF criteria). In patients with no improvement in ACLF grade or MELD (after 72 hours), were evaluated for PLEX (plasma exchange) (including alcohol hepatitis patients not eligible for steroid therapy or Lille score > 0.45 after 7 days) (Group A) and rest were continued on SMT (Group B). Low volume PLEX done on alternate days as per clinical response. Results: In our study 9(40.9 %) patients underwent 2 sessions of plasmapheresis followed by 3 sessions in (27.3 %),4 in (22.7%), 1(4.5%) 5(4.5%). In PLEX (n=22) group 12 (54.5 %) patients were discharged compared to 17 (34.0%) in the SMT (n=50) group (p=0.257). 30 days survival in the PLEX group was (n=16/81.25%) compared to (n=29/68.9%) (p=.321) in SMT. 90 days survival in the PLEX group was (n=13 / 38.46%) compared to (n=20 /60%) (p=0.99) in SMT group. In PLEX group (n=12 /54.5 %) patients discharged had significant decrease in MELD Na (35.46 +/- 4.63) as compared to pre PLEX MELD (32.15 +/- 5.47) (p=.004). No PLEX related severe adverse effect seen. Conclusion: In our study patients undergoing PLEX had increased hospital survival by 20 % and increase in 30 days survival by 10 % as compared to SMT group. However these values were not statistically significant due to small sample size. Hence PLEX may be a viable therapy in patients awaiting transplant by increasing short term survival. Further randomized control trials are needed to obtain robust conclusions.