Effects of therapeutic plasma exchange on early allograft dysfunction after liver transplantation

Choe, Wonho; Kwon, Sun Il; Kim, Sung‐Soo; Hwang, Shin; Song, Gi‐Won; Lee, Sung‐Gyu

doi:10.1002/jca.21472

Cited by 15 publications

(19 citation statements)

References 30 publications

(39 reference statements)

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“…A few reports have suggested the efficacy of TPE in liver support. 10,[14][15][16][17] In this regard, TPE can be used as a temporary support in liver failure until graft recovery or retransplantation. According to a report from Johns Hopkins Hospital, TPE provided an effective treatment option for dysfunctional liver allograft in four of five patients, and all four patients had functioning grafts 1 year after liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are no ASFA (American Society for Apheresis) 9 guidelines for the use of TPE for liver graft dysfunction in the setting hyperbilirubinemia, the decision to proceed with TPE was based on our institution's experience with managing similar situations and published literature demonstrating the utility of early TPE in liver graft dysfunction by removing excess bilirubin. 10 After obtaining informed consent, TPE was performed using the COBE Spectra apheresis system processing one blood volume with thawed plasma replacement (2600 mL) to reduce the risk of bleeding from worsening thrombocytopenia and coagulopathy. A central venous catheter was placed in the left internal jugular (IJ) vein for vascular access.…”

Section: Case Historymentioning

confidence: 99%

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Paradoxical embolic strokes in a liver transplant recipient with atrial septal defect undergoing therapeutic plasma exchange

Rodgers

Suneja

Yoshida

et al. 2020

J of Clinical Apheresis

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Therapeutic plasma exchange (TPE) is a technique used to separate blood components into layers based on their density difference, thus removing plasma and exchanging it with replacement fluids. A variety of adverse reactions has been described during TPE. Thrombotic events, especially strokes, are extremely rare complications of TPE. Our patient was a 55-year-old female with history of decompensated nonalcoholic steatohepatitis (NASH) liver cirrhosis. She underwent an orthotopic liver transplant (OLT) that was complicated with asystole during reperfusion. Cardiac workup revealed a new atrial septal defect (ASD) with left to right flow. Within the first 5 days after surgery, she developed refractory and persistent hyperbilirubinemia, with total bilirubin levels as high as 42 mg/dL. Our plasmapheresis service was consulted to initiate TPE. Towards

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Section: Discussionmentioning

confidence: 99%

Section: Case Historymentioning

confidence: 99%

Paradoxical embolic strokes in a liver transplant recipient with atrial septal defect undergoing therapeutic plasma exchange

Rodgers

Suneja

Yoshida

et al. 2020

J of Clinical Apheresis

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“…Studies of the treatment of hyperbilirubinemia after liver transplantation are limited. Choe et al [12] reported that therapeutic plasma exchange effectively removed plasma bilirubin and improved survival. Steroids are used to ameliorate hyperbilirubinemia in biliary atresia before and after transplantation [22,23], but studies are lacking to confirm its effect on hyperbilirubinemia after adult liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative hyperbilirubinemia is also a risk factor for graft loss in liver transplantation [8,9]. Although many studies have reported risk factors [3,10] and prevention strategies [11] for early graft dysfunction, few studies have investigated the treatment of hyperbilirubinemia caused by graft dysfunction [12].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Steroid Therapy for Posttransplant Hyperbilirubinemia Caused by Early Allograft Dysfunction: A Randomized Controlled Trial

Yang

et al. 2019

Med Sci Monit

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BackgroundHyperbilirubinemia is a common event that occurs after liver transplantation. Hyperbilirubinemia is usually caused by early allograft dysfunction. Glucocorticoid is widely used for immunosuppression, but few studies have analyzed the effects of steroid therapy on posttransplantation hyperbilirubinemia. The aim of this study was to assess whether glucocorticoid was beneficial in treating hyperbilirubinemia caused by early allograft dysfunction.Material/MethodsPatients with postoperative hyperbilirubinemia (those with conditions such as biliary complications and rejections were excluded) were randomly assigned, in a 2: 1 ratio, to the steroid and control groups. Patients in the steroid group were treated with glucocorticoid combined with ursodeoxycholic acid, whereas patients in the control group were only treated with ursodeoxycholic acid. The primary endpoint was decrease in bilirubin and the secondary endpoint was safety.ResultsFrom 1st June 2016 to 30th April 2018, 40 patients were enrolled into the steroid group, and 20 were enrolled into the control group. Donor, recipient, and operative data were similar between the 2 groups. The decrease in bilirubin levels in the steroid group was significantly greater than that in the control group on the first day after the intervention was finished (9.25±1.30 mg/dL vs. 3.11±1.45 mg/dL, p=0.005), and after 2 weeks (15.01±1.20 mg/dL vs. 8.88±1.98 mg/dL, p=0.007). The steroid group did not have a higher complication rate but it did have a shorter postoperative hospital stay than in the control group.ConclusionsLow-dose steroid therapy was effective and safe for treating hyperbilirubinemia caused by early graft dysfunction, and it improved liver function.

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“…The flow rate was roughly 40 ml/min, adjusted based on patient’s tolerance. Calcium gluconate was infused at a rate of 10–20 mg/h during the entire TPE period, titrated individually for each patient to prevent and treat adverse effects of hypocalcaemia 55 , 56 .…”

Section: Methodsmentioning

confidence: 99%

Prevalent metabolic derangement and severe thrombocytopenia in ABO-incompatible liver recipients with pre-transplant plasma exchange

Kwon

Jun

Lee

et al. 2018

Sci Rep

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Desensitisation with therapeutic plasma exchange (TPE) is essential for ABO-incompatible (ABO-I) liver transplants (LTs). However, excessive citrate load and coagulation disturbances after TPE have been poorly studied, in particular in cirrhotic patients with hypocapnic alkalosis, metabolic compensation and electrolyte imbalances. We retrospectively evaluated 1123 consecutive LT recipients (923 ABO-compatible [ABO-C], 200 ABO-I) from November 2008 to May 2015. TPE was generally performed a day before LT and blood sampling was performed before anaesthesia induction. We performed propensity score matching (PSM) and inverse probability treatment weighting (IPTW) analyses. In 199 PSM pairs, metabolic alkalosis was prevalent in ABO-I LT recipients (expectedly due to citrate conversion) with higher pH ≥ 7.50 (IPTW-adjusted odds ratio [aOR] = 2.23) than in ABO-C LT recipients. With increasing cirrhosis severity, the arterial pH and bicarbonate levels showed dose-dependent relationships, whereas mild hypoxaemia was more prevalent in ABO-I LT recipients. ABO-I LT recipients exhibited worsened hypokalaemia ≤3.0 mmol/l (17.6%, aOR = 1.44), hypomagnesaemia ≤1.7 mg/dl (27.6%, aOR = 3.43) and thrombocytopenia <30,000/µl (19.1%, aOR = 2.26) confirmed by lower maximal clot firmness (P = 0.001) in rotational thromboelastometry (EXTEM), which necessitated platelet transfusions. Preoperative identification of these change may prevent worsening of severe electrolyte disturbances and thrombocytopenia for optimal LT anaesthesia.

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Effects of therapeutic plasma exchange on early allograft dysfunction after liver transplantation

Abstract: TPE effectively removed plasma bilirubin and improved coagulation function in EAD patients, with higher survival in the TPE group than in the non-TPE group. TPE may be an effective liver support for EAD patients. J. Clin. Apheresis 32:147-153, 2017. © 2016 Wiley Periodicals, Inc.

Cited by 15 publications

References 30 publications

Paradoxical embolic strokes in a liver transplant recipient with atrial septal defect undergoing therapeutic plasma exchange

Paradoxical embolic strokes in a liver transplant recipient with atrial septal defect undergoing therapeutic plasma exchange

Efficacy and Safety of Steroid Therapy for Posttransplant Hyperbilirubinemia Caused by Early Allograft Dysfunction: A Randomized Controlled Trial

Prevalent metabolic derangement and severe thrombocytopenia in ABO-incompatible liver recipients with pre-transplant plasma exchange

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