Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure

Gastroenterology. 2012 Apr;142(4):782-789.e3. doi: 10.1053/j.gastro.2011.12.056. Epub 2012 Jan 13.


Background & aims: Fractionated plasma separation and adsorption (FPSA) is an extracorporeal procedure that supports liver function by removing endogenous toxins that cause complications from acute-on-chronic liver failure (AOCLF). We performed a randomized trial to investigate survival of patients with AOCLF treated with FPSA.

Methods: Patients with AOCLF were randomly assigned to groups given a combination of FPSA and standard medical therapy (SMT) (FPSA group, n = 77) or only SMT (SMT group, n = 68). The Prometheus liver support system was used to provide 8 to 11 rounds of FPSA (minimum of 4 hours each) for 3 weeks. Primary end points were survival probabilities at days 28 and 90, irrespective of liver transplantation.

Results: Baseline clinical parameters and number of transplant patients were similar between study arms. Serum bilirubin level decreased significantly in the FPSA group but not in the SMT group. In an intention-to-treat analysis, the probabilities of survival on day 28 were 66% in the FPSA group and 63% in the SMT group (P = .70); on day 90, they were 47% and 38%, respectively (P = .35). Baseline factors independently associated with poor prognosis were high SOFA score, bleeding, female sex, spontaneous bacterial peritonitis, intermediate increases in serum creatinine concentration, and combination of alcoholic and viral etiology of liver disease. There were no differences between the 2 groups in the incidence of side effects.

Conclusions: Among all patients with AOCLF, extracorporeal liver support with FPSA does not increase the probability of survival. Further studies are needed to assess whether therapy might be beneficial in specific subsets of patients.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bilirubin / blood
  • Biomarkers / blood
  • End Stage Liver Disease / diagnosis
  • End Stage Liver Disease / mortality
  • End Stage Liver Disease / therapy*
  • Europe
  • Extracorporeal Circulation* / adverse effects
  • Extracorporeal Circulation* / mortality
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver Failure, Acute / diagnosis
  • Liver Failure, Acute / mortality
  • Liver Failure, Acute / therapy*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Sorption Detoxification* / adverse effects
  • Sorption Detoxification* / mortality
  • Time Factors
  • Treatment Outcome


  • Biomarkers
  • Bilirubin

Associated data

  • ISRCTN/ISRCTN50777531