Increasing use of therapeutic apheresis as a liver-saving modality

Lee, Hyunji; Shin, Kyung‐Hwa; Song, Duyeal; Lee, Sun Min; Chang, Chulhun L.; Chu, Chong Woo; Ryu, Je Ho; Lee, Tae Bum; Park, Yong-Mok; Yang, Kwangho; Choi, Byung Hyun; Kim, Hyung Hoi

doi:10.1016/j.transci.2017.03.001

Cited by 2 publications

(1 citation statement)

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“…1. Data from nine studies were included in the review, of which five reported the use of MARS and four reported the use of PE; [18][19][20][21][22][23][24][25][26] no other LSS were reported.…”

Section: Search Criteriamentioning

confidence: 99%

Role of liver support systems in the management of post hepatectomy liver failure: A systematic review of the literature

Pufal

Lawson

Hodson

et al. 2021

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims: Post-hepatectomy liver failure (PHLF) is a serious complication following liver resection, with limited treatment options, and is associated with high mortality. There is a need to evaluate the role of systems that support the function of the liver after PHLF. Aims: The aim of this study was to review the literature and summarize the role of liver support systems (LSS) in the management of PHLF. Publications of interest were identified using systematically designed searches. Following screening, data from the relevant publications was extracted, and pooled where possible. Findings: Systematic review identified nine studies, which used either Plasma Exchange (PE) or Molecular Adsorbent Recirculating System (MARS) as LSS after PHLF. Across all studies, the pooled 90-day mortality rate was 38% (95% CI: 9-70%). However, there was substantial heterogeneity, likely since studies used a variety of definitions for PHLF, and had different selection criteria for patient eligibility for LSS treatment. Conclusions: The current evidence is insufficient to recommend LSS for the routine management of severe PHLF, with the current literature consisting of only a limited number of studies. There is a definite need for larger, multicenter, prospective studies, evaluating the conventional and newer modalities of support systems, with a view to improve the outcomes in this group of patients.

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Section: Search Criteriamentioning

confidence: 99%

Role of liver support systems in the management of post hepatectomy liver failure: A systematic review of the literature

Pufal

Lawson

Hodson

et al. 2021

Ann Hepatobiliary Pancreat Surg

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Risk assessment for hypocalcemia in therapeutic apheresis for kidney transplantation

Okwuonu,

Shah,

Rafique

et al. 2024

Ther Apher Dial

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IntroductionThe increase in the number of kidney transplants performed in the United States has been paralleled with an increase in the utilization of therapeutic apheresis (TA) for kidney transplant indications. Hypocalcemia remains a significant contributor to the adverse event in TA. The magnitude of hypocalcemia and its risk factors are scarcely discussed in literature.MethodsThis is a retrospective cohort review of adults from 18 years and above who received TA for kidney transplant‐related indications from January 1, 2017 to December 31, 2022. Data extracted included basic demographics, indication for apheresis, procedure characteristics, serum ionized calcium at the mid and end of procedure and serum creatinine at the beginning of apheresis, and so forth.ResultsData from 131 patients and 860 sessions of TA were analyzed. Antibody‐mediated rejection (69%) and recurrent FSGS (15%) were the leading indications for TA. There were 60 (7%) TA sessions complicated by hypocalcemia. Of these, 53 (88%) occurred in the first session, 5 (8%) occurred in second session while 2 (4%) occurred in the third and subsequent sessions. Female sex, elevated serum creatinine and use of fresh frozen plasma‐ are the risk factors for hypocalcemia with odd's ratio of 2.34, 7.42, and 5.01, respectively. Binary logistic regression showed that elevated serum creatinine at the commencement of therapy is an independent predictor of hypocalcemia (adjusted odd's ratio = 3.31, p = 0.001).ConclusionHypocalcemia is prevalent in this study. Clinical vigilance and tailored procedure will avert adverse consequences.

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Increasing use of therapeutic apheresis as a liver-saving modality

Cited by 2 publications

References 18 publications

Role of liver support systems in the management of post hepatectomy liver failure: A systematic review of the literature

Role of liver support systems in the management of post hepatectomy liver failure: A systematic review of the literature

Risk assessment for hypocalcemia in therapeutic apheresis for kidney transplantation

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