Comparative Analysis of Plasmapheresis Versus Plasmapheresis Combined With Continuous Renal Replacement Therapy in Adult Liver Failure: A Retrospective Observational Study

Abstract

Background: Liver failure constitutes a critical medical condition marked by the rapid decline in hepatic functions. Novel therapeutic approaches, including therapeutic plasma exchange (TPE) and continuous venovenous hemodiafiltration (CVVHDF), have emerged as promising modalities for mitigating the effects of this condition by facilitating detoxification and enhancing liver function. The efficacy of these interventions, whether administered individually or in combination, is a prominent area of investigation in the management of liver failure among adult populations. This study aims to evaluate the role and effectiveness of TPE, both as a standalone treatment and in conjunction with CVVHDF, in the management of liver failure in adult patients.

Methods: This retrospective study was conducted in a Liver Transplant Intensive Care Unit (LTICU), focusing on the medical records of adult patients aged 35 to 62 years. The patient cohort consisted of individuals admitted between January 1, 2021, and June 1, 2024, due to acute liver failure or acute-on-chronic liver failure. The analysis specifically included patients who underwent therapeutic plasma exchange (TPE) or those who received continuous renal replacement therapy in conjunction with TPE. For the statistical analysis, a P-value of less than .05 was deemed indicative of statistical significance. The study encompassed a total of 47 patients with liver failure, comprising 23 males and 24 females. Among these patients, 25 (53.2%) received only TPE, while 22 (46.8%) were treated with a combination of TPE and continuous venovenous hemodiafiltration (CVVHDF).

Results: In the cohort of patients who received only therapeutic plasma exchange (TPE), the median International Normalized Ratio (INR) improved significantly, decreasing from 2 (1.6-2.6) to 1.3 (1.1-1.7). Similarly, alanine aminotransferase levels reduced from 351 (66-1482) to 166 (71-367), while aspartate aminotransferase levels decreased from 259 (132-1392) to 86 (35-160). In the group receiving a combination of TPE and continuous venovenous hemodiafiltration (CVVHDF), notable reductions were also observed: INR decreased from 3 (2.4-4.7) to 1.5 (1.3-2.4), alanine aminotransferase levels dropped from 691 (59-2397) to 162 (70-1060), and aspartate aminotransferase levels fell from 916 (134-1828) to 69 (45-503). These changes were statistically significant, with P-values of less than .05 for each parameter in both treatment groups. Overall, 21 patients achieved survival without requiring a liver transplant, while 7 patients underwent liver transplantation, resulting in a transplant-free survival rate of 44.7%.

Conclusion: The findings from our study on the management of liver failure in adults demonstrate that both therapeutic plasma exchange (TPE) administered alone and in conjunction with continuous venovenous hemodiafiltration (CVVHDF) are effective treatment modalities, particularly as a bridging strategy to liver transplantation. The observed transplant-free survival rate of 44.7% underscores the significant clinical advantages of these therapies. However, to enhance the validity of these results and their applicability in broader clinical contexts, additional multicenter studies are essential for further exploration of these treatment approaches in liver failure management.