The plasma exchange is an effective measure in the treatment of acute liver failure. The authors report their own first experiences in this field in the management of fulminant viral hepatitis. Four out of 7 treated patients survived. So, the survival rate was augmented from 25 per cent in a control group of 8 patients without plasma exchange to 57.1 per cent. Other necessary therapeutic measures are high energetic nutrition, branched chained amino acids, stimulation of liver cell regeneration, correction of coagulation alterations, and intensive care. The success depends on coma stage in the beginning of treatment. Patients with signs of praecoma should be admitted to specialized centers. The number of such centers should be limited because of the necessary experiences and the high costs of combined plasma exchange treatment of this rare hepatitis complication.