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High-volume plasma exchange in patients with acute liver failure: An open randomised controlled trial
Abstract
Background & aims Acute liver failure (ALF) often results in cardiovascular instability, renal failure, brain oedema and death either due to irreversible shock, cerebral herniation or development of multiple organ failure. High-volume plasma exchange (HVP), defined as exchange of 8-12 or 15% of ideal body weight with fresh frozen plasma in case series improves systemic, cerebral and splanchnic parameters. Methods In this prospective, randomised, controlled, multicentre trial we randomly assigned 182 patients with ALF to receive either standard medical therapy (SMT; 90 patients) or SMT plus HVP for three days (92 patients). The baseline characteristics of the groups were similar. The primary endpoint was liver transplantation-free survival during hospital stay. Secondary-endpoints included survival after liver transplantation with or without HVP with intention-to-treat analysis. A proof-of-principle study evaluating the effect of HVP on the immune cell function was also undertaken. Results For the entire patient population, overall hospital survival was 58.7% for patients treated with HVP vs. 47.8% for the control group (hazard ratio (HR), with stratification for liver transplantation: 0.56; 95% confidence interval (CI), 0.36-0.86; p=0.0083). HVP prior to transplantation did not improve survival compared with patients who received SMT alone (CI 0.37 to 3.98; p=0.75). The incidence of severe adverse events was similar in the two groups. Systemic inflammatory response syndrome (…
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Studies have suggested that an artificial liver (e.g., plasma replacement therapy or a double plasma molecular absorption system) may improve transplant-free survival.
“Studies have suggested that an artificial liver (e.g., plasma replacement therapy or a double plasma molecular absorption system) may improve transplant-free survival [218].”
From Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update (2024) · cites this paper as [218]
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Liver — guardian, modifier and target of sepsis
Strnad, P., Tacke, F., Koch, A., & Trautwein, C. (2017) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2016.168 · Cited by 692
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Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update
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Metadata
- Authors
- Larsen, F. S., Schmidt, L. E., Bernsmeier, C., Rasmussen, A., Isoniemi, H., Patel, V. C., Triantafyllou, E., Bernal, W., Auzinger, G., Shawcross, D., Eefsen, M., Bjerring, P. N., Clemmesen, J. O., Hockerstedt, K., Frederiksen, H.-J., Hansen, B. A., Antoniades, C. G., & Wendon, J.
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 64
- Issue
- 1
- Pages
- 69-78
- ISSN
- 0168-8278
- Cited by
- 659
- References
- 3
- Language
- en
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