TY - JOUR
T1 - Safety of High-Volume Plasmapheresis in Children With Acute Liver Failure
AU - Jørgensen, Marianne Hørby
AU - Rasmussen, Allan
AU - Christensen, Vibeke Brix
AU - Jensen, Anne-Mette Bæk
AU - Fonsmark, Lise
AU - Andreassen, Bente Utoft
AU - Damholt, Mette Brimnes
AU - Larsen, Fin Stolze
N1 - Copyright © 2021 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - OBJECTIVES: Paediatric acute liver failure (P-ALF) is a rare condition and is associated with a high mortality rate. Management of P-ALF aims to stabilise vital organ functions and to remove circulating toxins and provide vital plasma factors that are lacking. High-volume plasmapheresis (HVP) removes protein-bound substances and improves survival in adult ALF. It is unknown if this effect can be extrapolated to P-ALF. The aim of this study is to report the safety and feasibility of HVP in P-ALF.METHODS: Children with P-ALF were offered HVP if bilirubin was higher than 200 μmol/L or if the aetiology was toxic hepatitis. HVP was performed with fresh frozen plasma corresponding to 10% of the body weight on a minimum of 3 consecutive days. Diagnostics, biochemical and clinical data during HVP as well as outcome data after 3 months were collected from 2012 to 2019 and retrospectively analysed.RESULTS: Sixteen children were treated by HVP and completed at least one series of three treatment sessions with HVP. The only complication seen was an increase in pH > 7.55 in three children within the first 12 hours and was corrected with hydrochloric acid. No bleeding or septic episodes were noted during HVP. Eight children survived without liver transplantation, two survived after successful grafting and a total of six children died. The liver injury unit score between survivors with their own liver and the rest, the two groups was significantly different (P = 0.005).CONCLUSION: HVP with fresh frozen plasma is feasible and well tolerated in children with P-ALF. No serious adverse events and no procedure-related mortality were observed.
AB - OBJECTIVES: Paediatric acute liver failure (P-ALF) is a rare condition and is associated with a high mortality rate. Management of P-ALF aims to stabilise vital organ functions and to remove circulating toxins and provide vital plasma factors that are lacking. High-volume plasmapheresis (HVP) removes protein-bound substances and improves survival in adult ALF. It is unknown if this effect can be extrapolated to P-ALF. The aim of this study is to report the safety and feasibility of HVP in P-ALF.METHODS: Children with P-ALF were offered HVP if bilirubin was higher than 200 μmol/L or if the aetiology was toxic hepatitis. HVP was performed with fresh frozen plasma corresponding to 10% of the body weight on a minimum of 3 consecutive days. Diagnostics, biochemical and clinical data during HVP as well as outcome data after 3 months were collected from 2012 to 2019 and retrospectively analysed.RESULTS: Sixteen children were treated by HVP and completed at least one series of three treatment sessions with HVP. The only complication seen was an increase in pH > 7.55 in three children within the first 12 hours and was corrected with hydrochloric acid. No bleeding or septic episodes were noted during HVP. Eight children survived without liver transplantation, two survived after successful grafting and a total of six children died. The liver injury unit score between survivors with their own liver and the rest, the two groups was significantly different (P = 0.005).CONCLUSION: HVP with fresh frozen plasma is feasible and well tolerated in children with P-ALF. No serious adverse events and no procedure-related mortality were observed.
KW - Adult
KW - Chemical and Drug Induced Liver Injury
KW - Child
KW - Humans
KW - Liver Failure, Acute/etiology
KW - Liver Transplantation
KW - Plasmapheresis
KW - Retrospective Studies
KW - CRP
KW - P-ALF
KW - C-reactive protein
KW - HVP
KW - continuous renal replacement therapy
KW - ammonia
KW - critical care
KW - ALT
KW - high-volume plasmapheresis
KW - artificial liver support
KW - fulminant hepatic failure
KW - liver injury unit score
KW - multiorgan dysfunction
KW - MOD
KW - gestational allogen liver disease
KW - Liu score
KW - CRRT
KW - HCL
KW - GALD
KW - acute liver failure
KW - Alanine aminotransferase
KW - ALF
KW - hydrochloric acid
KW - HE
KW - Hepatic encephalopathy
KW - paediatric acute liver failure
UR - http://www.scopus.com/inward/record.url?scp=85106540691&partnerID=8YFLogxK
U2 - 10.1097/MPG.0000000000003108
DO - 10.1097/MPG.0000000000003108
M3 - Journal article
C2 - 33633079
VL - 72
SP - 815
EP - 819
JO - Journal of Pediatric Gastroenterology and Nutrition
JF - Journal of Pediatric Gastroenterology and Nutrition
SN - 0277-2116
IS - 6
ER -