Lusutrombopag for Thrombocytopenia in Patients With Chronic Liver Disease Undergoing Invasive Procedures: A Systematic Review and Meta-analysis

Plasma exchange, a promising liver support system with still relevant uncertainties

“…The certainty of evidence was however low, especially in ACLF. The authors concluded that PE may be considered in managing ALF or ACLF, either in non-LT candidates or in eligible patients, as a bridge to LT. [8] The results of this meta-analysis show a likely survival benefit in patients with ALF treated with PE, supporting the recommendations done by EASL and the American Society for Apheresis (ASFA). The European Association for the Study of Liver (EASL) guidelines suggest its use in non-LT candidates, while ASFA considers PE as a category I (first-line) therapy (evidence grade 1A) in ALF.…”

“…[7] A recent randomized controlled trial (RCT) confirms the beneficial effects of PE in ALF and shows that lower doses of PE (1.5-2 plasma volumes) are equally effective. [8] Fresh frozen plasma was used as the main replacement fluid in both studies. PE ameliorated systemic inflammation, damping the proinflammatory profile of the innate immune system, an effect that improved intracranial hypertension and macro and microcirculation, and could also contribute to reducing tissue damage.…”

“…The first study reporting beneficial effects on the survival of PE in ALF was published by Larsen et al High-volume PE improved transplant-free survival in these patients 7 . A recent randomized controlled trial (RCT) confirms the beneficial effects of PE in ALF and shows that lower doses of PE (1.5–2 plasma volumes) are equally effective 8 . Fresh frozen plasma was used as the main replacement fluid in both studies.…”

“…The certainty of evidence was however low, especially in ACLF. The authors concluded that PE may be considered in managing ALF or ACLF, either in non-LT candidates or in eligible patients, as a bridge to LT 8 …”