Role of plasmapheresis in the management of acute hepatic failure in children

Objective To assess the efficacy of plasmapheresis in the treatment of chil dren with acute hepatic failure. Summary Background Data Acute liver failure is expressed with severe enceph alopathy, coagulopathy, and subsequent multisystem organ failure, resulting in a high death rate. Liver transplantation is considered the best option, with long-term 1-year survival rates exceeding 88%. It has been suggested that plasmapheresis may improve coagulopathy and prevent bleeding complicat ions while maintaining adequate fluid, electrolyte, and acid-base balance. Methods Forty-nine patients with acute liver failure underwent a total of 2 43 therapeutic plasma exchanges (TPE). Indications for treatment included c andidacy for liver transplant and prolonged prothrombin time. Pheresis was performed daily until the patient recovered, died, or was transplanted. Fou r patients were anhepatic during pheresis. Results Coagulation profiles after TPE significantly improved compared with mean preexchange values while maintaining euvolemia. No bleeding episodes were observed during the course of treatment. There was no sustained improv ement in neurologic function. Spontaneous recovery was observed in three pa tients; the remaining either underwent transplantation (32/49) or were not considered transplant candidates because of irreversible neurologic insults (11/49) or sepsis (3/49). Conclusion For children with acute liver failure, TPE is extremely effectiv e in preventing life-threatening bleeding while maintaining appropriate vol ume status in small children. This method of treatment has no effect on the neurologic complications of liver failure and has no impact on the ability of the liver to regenerate.