Plasma exchange does not improve overall survival in patients with acute liver failure in a real world cohort

IF 26.8 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepatology Pub Date : 2024-10-01 DOI:10.1016/j.jhep.2024.09.034

Laura Burke, William Bernal, Tasneem Pirani, Banwari Agarwal, Rajiv Jalan, Jennifer Ryan, Mansoor.Nawaz Bangash, Phillip El-Dalil, Nick Murphy, Mhairi Donnelly, Janice Davidson, Ken Simpson, Hannah Giles, Phyo Set Mone, Steven Masson, Andrew Davenport, Ian Rowe, Joanna Moore

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Abstract

Background and Aims

Therapeutic plasma exchange (PEX) has emerged as a potential treatment option for patients with acute liver failure (ALF). The effect of PEX on survival outcomes outside of clinical trials is not yet well established. In this study we aimed to evaluate the real-world use and outcomes of PEX for the treatment of ALF.

Methods

This multicentre retrospective cohort study included consecutive patients with ALF admitted to all 7 tertiary liver transplant centres in the United Kingdom (UK) between June 2013 and December 2021. Changes in clinical variables following PEX treatment was assessed and overall survival and transplant free survival (TFS) to hospital discharge of patients receiving PEX were compared to those receiving standard medical therapy (SMT). Propensity score matching was performed to control for intergroup covariates and selection bias.

Results

We included 378 patients with ALF (median (IQR) age 36 (28-48), 64% (n=242) female) of which 120 received PEX. There was a significant improvement in most clinical variables following PEX, including median dose of noradrenaline (reduction from 0.35 μg/kg/min (0.19 - 0.70 μg/kg/min) to 0.16 μg/kg/min (0.08 - 0.49) (p = 0.001). There was no significant difference between PEX and SMT groups in overall survival (51.4 % v 62.6 % respectively, p = 0.12) or TFS (42.6 % v 53.1 %, p = 0.24).

Conclusion

PEX is now frequently used in the management of ALF patients in the UK. It is associated with significant improvement in haemodynamic parameters but there is no survival benefit.

Abstract Image

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在一个真实世界的队列中，血浆置换并不能改善急性肝衰竭患者的总生存率

背景和目的治疗性血浆置换（PEX）已成为急性肝衰竭（ALF）患者的一种潜在治疗选择。在临床试验之外，治疗性血浆置换对生存结果的影响尚未得到充分证实。这项多中心回顾性队列研究纳入了 2013 年 6 月至 2021 年 12 月期间入住英国 7 家三级肝移植中心的连续 ALF 患者。研究人员评估了PEX治疗后临床变量的变化，并将接受PEX治疗的患者与接受标准药物治疗（SMT）的患者出院后的总生存率和无移植生存率（TFS）进行了比较。结果我们纳入了378例ALF患者（中位数（IQR）年龄36（28-48）岁，64%（n=242）为女性），其中120例接受了PEX治疗。PEX 后，大多数临床变量都有明显改善，包括去甲肾上腺素的中位剂量（从 0.35 μg/kg/min (0.19 - 0.70 μg/kg/min) 降至 0.16 μg/kg/min (0.08 - 0.49) (p = 0.001)。PEX组和SMT组在总生存率（分别为51.4%对62.6%，p = 0.12）或TFS（42.6%对53.1%，p = 0.24）方面没有明显差异。PEX可明显改善血流动力学参数，但对生存没有益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hepatology 医学-胃肠肝病学

CiteScore

46.10

自引率

4.30%

发文量

2325

审稿时长

30 days

期刊介绍： The Journal of Hepatology is the official publication of the European Association for the Study of the Liver (EASL). It is dedicated to presenting clinical and basic research in the field of hepatology through original papers, reviews, case reports, and letters to the Editor. The Journal is published in English and may consider supplements that pass an editorial review.