Published online Aug 27, 2021. doi: 10.4254/wjh.v13.i8.904
Peer-review started: March 7, 2021
First decision: March 29, 2021
Revised: April 2, 2021
Accepted: July 20, 2021
Article in press: July 20, 2021
Published online: August 27, 2021
Processing time: 165 Days and 16.7 Hours
The multi-organ failure syndrome associated with acute and acute-on-chronic liver failure (ACLF) is thought to be mediated by overwhelming systemic inflammation triggered by both microbial and non-microbial factors. Therapeutic plasma exchange (TPE) has been proven to be an efficacious therapy in autoimmune conditions and altered immunity, with more recent data supporting its use in the management of liver failure. Few therapies have been shown to improve survival in critically ill patients with liver failure who are not expected to survive until liver transplantation (LT), who are ineligible for LT or who have no access to LT. TPE has been shown to reduce the levels of inflammatory cytokines, modulate adaptive immunity with the potential to lessen the susceptibility to infections, and reduce the levels of albumin-bound and water-bound toxins in liver failure. In patients with acute liver failure, high volume TPE has been shown to reduce the vasopressor requirement and improve survival, particularly in patients not eligible for LT. Standard volume TPE has also been shown to reduce mortality in certain sub-populations of patients with ACLF. TPE may be most favorably employed as a bridge to LT in patients with ACLF. In this review, we discuss the efficacy and technical considerations of TPE in both acute and acute-on-chronic liver failure.
Core Tip: Multi-organ failure accompanying liver failure is mediated by overwhelming systemic inflammation and altered host immunity. Therapeutic plasma exchange has been proven to be an efficacious therapy in autoimmune conditions and altered immunity. We review the efficacy and technical considerations of therapeutic plasma exchange in both acute and acute-on-chronic liver failure.