Therapeutic effect of double plasma molecular adsorption system and sequential half‐dose plasma exchange in patients with HBV‐related acute‐on‐chronic liver failure

Abstract

Objective The artificial liver support system (ALSS) is used frequently as a first‐line treatment for hepatitis B virus‐associated acute‐on‐chronic liver failure (HBV‐ACLF). This study aims to compare the therapeutic efficacy of double plasma molecular adsorption system (DPMAS) with sequential half‐dose plasma exchange (PE) (DPMAS+PE) and full‐dose PE in patients with HBV‐ACLF. Methods A total of 131 hospitalized patients who were diagnosed with HBV‐ACLF and underwent DPMAS+PE or PE were retrospectively analyzed. According to the treatment methods used, they were divided into PE group (n = 77) and DPMAS+PE group (n = 54). The main evaluation indexes included the change of liver function and the 28‐days liver transplant‐free survival rates after the different treatments. Results There were no significant differences on severity of illness between PE group and DPMAS+PE group (P > 0.05). The total bilirubin (TBIL) levels immediately after treatment, and at 24 and 72 hours after treatment were markedly decreased in DPMAS+PE group than that in PE group (52.3 ± 9.4% vs 42.3 ± 7.2%, P < 0.05; 24.2 ± 10.0% vs 13.5 ± 13.0%, P < 0.05; 24.8 ± 13.1% vs 14.9 ± 14.9%, P < 0.05; respectively). The 28‐days survival rates was 62.3% and 72.2% in PE and DPMAS+PE groups (P = 0.146). Furthermore, the 28‐days survival rates were significantly higher in DPMAS+PE group than that in PE group (57.4% vs 41.7%, P = 0.043) in the intermediate‐advanced stage patients. Conclusion Compared with PE alone, DPMAS+PE might more effectively improve temporary TBIL in ACLF patients, and improve the 28‐days survival rates in HBV‐ACLF patients with intermediate‐advanced stage. Therefore, DPMAS+PE may be an available ALSS treatment for HBV‐ACLF patients.

Acute kidney injury spectrum in patients with chronic liver disease: Where do we stand?

“…The double plasma molecular absorption system is more sophisticated than plasma perfusion and bilirubin adsorption, combining both with an adsorbent for the reduction in inflammatory mediators, drugs or toxins (Figure 5). Although the rationale for using these systems seems to be that they will improve our understanding of ACLF pathophysiology, most studies on the double plasma molecular absorption system are in patients with hepatitis B-related liver failure[92-94]. In our experience, the double plasma molecular absorption system decreased bilirubin and ammonia 25%-30% from baseline after one treatment session in patients with ACLF and cancer (unpublished data).…”

Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient during COVID-19 Pandemic: Expert Review and Recommendation

“…Conjugated or unconjugated bilirubin, bile acids, phenols, fatty acids, cytokines, ammonia, or amino acids can be effectively removed by high-volume plasmapheresis, improving liver function through amelioration of the inflammatory response [29]. For the same purpose, double plasma molecular adsorption system and sequential half-dose plasma exchange have been utilized [30]. The use of hemoperfusion is expanding, thanks to new biocompatible sorbent cartridges.…”

“…Nonetheless, no RCTs have been able to demonstrate a beneficial effect. Recently, the use of double plasmafiltration molecular adsorption system has been described for the above-mentioned indications in a small trial [30]. Hemoperfusion is a method of blood purification based on the interaction between a sorbent and target molecules.…”

SARS-CoV-2 and Viral Sepsis: Immune Dysfunction and Implications in Kidney Failure

“…Park et al [ 156 ] showed that CRRT reduced the serum levels of IL6 and IL8 in septic disease. Moreover, a randomized clinical trial underlined that the early use of CRRT could significantly reduce the index of mortality in critically ill patients with renal damage [ 157 ].…”