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. 2025 Jan-Feb;15(1):101934.
doi: 10.1016/j.jceh.2024.101934. Epub 2024 Jul 15.

Adverse Events and Outcomes of High-volume Plasma Exchange in 50 Acute Liver Failure Patients: A Monocentric Retrospective Real-world Study

Valentin Coirier  1   2 , Quentin Quelven  1   2 , Pauline Guillot  1   2 , Flora Delamaire  1   2 , Pauline Houssel-Debry  2   3 , Adel Maamar  1   2 , Benoît Painvin  1   2 , Arnaud Gacouin  1   2 , Mathieu Lesouhaitier  1   2 , Michel Rayar  2   4 , Isabelle Grulois  5 , Nicolas Terzi  1   2 , Jean-Marc Tadié  1   2 , Christophe Camus  1   2
Affiliations

Adverse Events and Outcomes of High-volume Plasma Exchange in 50 Acute Liver Failure Patients: A Monocentric Retrospective Real-world Study

Valentin Coirier et al. J Clin Exp Hepatol. 2025 Jan-Feb.

Abstract

Background and aims: Acute liver failure (ALF) is a condition that mostly requires Intensive Care Unit (ICU) admission and sometimes necessitates emergency liver transplantation. High-volume plasma exchange (HVPE) may improve transplant-free survival (TFS) in ALF. Our study assessed complications of HVPE therapy and outcome in ALF patients.

Methods: We conducted a single-center retrospective study of all patients admitted to the ICU for ALF and who underwent HVPE between June 2016 and June 2021. The plasmapheresis technique used was centrifugation, and the volume exchanged was calculated as 15% of the ideal body weight. Dedicated staff prospectively collected clinical adverse effects, while biological data were retrospectively collected. The primary outcome was the rate of severe adverse effects (SAE, defined as severe manifestations of hypotension, allergy, metabolic disturbances or other life-threatening event) that occurred during HVPE sessions. Factors influencing day-21 TFS were also studied.

Results: One hundred twenty sessions were performed in 50 patients. The main etiology for ALF was paracetamol (52% of the patients). During the session, hemoglobin, platelet, transaminases, ammonia and bilirubin decreased, coagulation factors increased, and creatinine and lactate remained unchanged. At least one SAE was reported for 32 out of 120 sessions (26.7% [19%-35.5%], mostly severe alkalosis [24/117], hypotension [4/120] and hypocalcemia [4/119]). Arterial pH ≤ 7.43 following HVPE and paracetamol etiology were negatively and positively associated with day-21 TFS, respectively.

Conclusion: Severe adverse effects were frequent during HVPE performed for ALF, mainly severe alkalosis, hypotension and hypocalcemia. Post-HVPE, pH and paracetamol etiology were prognosis markers.

Keywords: acute liver failure; adverse effects; high-volume plasma exchange.

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