High-volume plasma exchange for acute liver failure: A retrospective study of 45 patients in Vietnam

Abstract

High-volume plasma exchange (HVP) has been proposed as an adjunctive therapy for acute liver failure (ALF), with prior randomized trials showing improved transplant-free survival. We conducted a retrospective, single-center study of 45 acute liver failure patients who received HVP at the Poison Control Center, Bach Mai Hospital, Hanoi, Vietnam, to describe the 28-day outcomes, treatment-related complications, and factors associated with survival. Patient variables including age, gender, etiology, survival at 28 days, international normalized ratio (INR), plasma volume per exchange, hospital stay, and complications were collected. Data were analyzed using SPSS 27. Descriptive statistics (mean ± SD, median ± IQR) were applied, and INR was compared between survivors and non-survivors using t-test (p < 0.05). The mean age was 47 ± 16 years; 24 (53.3 %) were male. Leading etiologies were traditional medicine/herbal use 22(48.9 %), paracetamol 9(20.0 %), and other causes 14(31.1 %). The 28-day survival rate was 53.3 % (24/45). Mean INR at admission was 3.30 ± 2.45; survivors had lower INR (2.67) than non-survivors (4.02), though not statistically significant (p = 0.082). Each HVP used a mean plasma volume of 8.27 ± 1.19 L. Mean hospital stay was 9.8 ± 7.3 days. Complications included anaphylaxis/allergic reactions in 13 (28.9 %) and bleeding in 2 (4.4 %), while no complications occurred in 30 (66.7 %) patients. In this cohort, HVP (mean 8.27 L per exchange) was associated with a 28-day survival rate of 53.3 %, comparable to that reported in previous studies, though causality cannot be inferred due to the absence of a control group. Our findings highlight the high prevalence of ALF from traditional medicine in Vietnam and support the need for prospective, multicenter studies to refine prognostic factors and optimize HVP protocols. These results support the use of HVP as a feasible and safe supportive therapy in resource-limited settings.Limitationsin our study include the retrospective design, single-center setting, small sample size, and absence of a control group. This study was approved by the Institutional Ethics Committee of Bach Mai Hospital, Hanoi, Vietnam.