High-volume plasma exchange (HVPLEX) in acute liver failure (ALF): A tertiary care perspective

Apheresis requires curtail patient monitoring. Beforehand, CBC, electrolytes, & coagulation profiles need to be checked. During the procedure, ensuring patient comfort & monitoring vital signs are essential. The rate of adverse events during TPE is typically 4-5%, with the first procedure carrying a slightly higher risk. Fortunately, we haven't encountered major complications like vasovagal attacks, anaphylactic reactions, hypovolemia, or hypocalcemia per procedure.

To maintain calcium homeostasis, Inj. Calcium Gluconate was used, frequent EKG monitoring of QTc helps mitigate any signs of hypocalcemia. Vascular access was gained from femoral or central venous catheters. We primarily use group-specific FFPs, which are the safest, but AB group FFP can be used when specific types aren't available. A continuous centrifugation cell separator was used, maintaining a blood flow of 50ml/min, with frequent vital sign monitoring.

In ALF, pro-inflammatory cytokines and toxic metabolites significantly contribute to multi-organ failure (MOF). Success of HVPLEX depends on removing these disease mediators; more plasma removed means more mediators eliminated. For ALF patients without spontaneous recovery, liver transplantation remains the only definitive treatment. Very few studies have looked at the role of HVPLEX treatment in Acute Liver Failure and also in ACLF. Further studies require to assess the benefits of HVPLEX in specific etiology of ALF. Our experience is HVPLEX can provide a crucial bridge, buying time until patients become suitable for transplantation.