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Safety of High-Volume Plasmapheresis in Children With Acute Liver Failure

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@article{85950332c8884ffa9df9c49c4d0fbd85,
title = "Safety of High-Volume Plasmapheresis in Children With Acute Liver Failure",
abstract = "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.",
keywords = "Adult, Chemical and Drug Induced Liver Injury, Child, Humans, Liver Failure, Acute/etiology, Liver Transplantation, Plasmapheresis, Retrospective Studies, CRP, P-ALF, C-reactive protein, HVP, continuous renal replacement therapy, ammonia, critical care, ALT, high-volume plasmapheresis, artificial liver support, fulminant hepatic failure, liver injury unit score, multiorgan dysfunction, MOD, gestational allogen liver disease, Liu score, CRRT, HCL, GALD, acute liver failure, Alanine aminotransferase, ALF, hydrochloric acid, HE, Hepatic encephalopathy, paediatric acute liver failure",
author = "J{\o}rgensen, {Marianne H{\o}rby} and Allan Rasmussen and Christensen, {Vibeke Brix} and Jensen, {Anne-Mette B{\ae}k} and Lise Fonsmark and Andreassen, {Bente Utoft} and Damholt, {Mette Brimnes} and Larsen, {Fin Stolze}",
note = "Copyright {\textcopyright} 2021 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.",
year = "2021",
month = jun,
day = "1",
doi = "10.1097/MPG.0000000000003108",
language = "English",
volume = "72",
pages = "815--819",
journal = "Journal of Pediatric Gastroenterology and Nutrition",
issn = "0277-2116",
publisher = "Lippincott Williams & Wilkins",
number = "6",

}

RIS

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 -

ID: 63752900