Systematic Review
Copyright ©The Author(s) 2020.
World J Gastroenterol. Jan 14, 2020; 26(2): 219-245
Published online Jan 14, 2020. doi: 10.3748/wjg.v26.i2.219
Table 3 Studies included in for study of plasmapheresis in acute liver failure in pediatric cohort
Ref.Type of study / No. of patients recruitedStudy group(s)Plasma exchange regimeEtiology; AgeResults
Pham et al[19]Case seriesPE, No comparative armPlasma volume: Targeted 1-1.25 plasma volumesWilsons DiseasePost TPE 9 patients underwent liver transplantation and all 10 patients had at least 6 mo survival
n = 10
Age 6-61 yr
Median days from first to OLT was 1-53 d
Plasma exchange fluid: 77% of procedures were performed with plasma as sole replacement fluid while 23% used the combination of plasma and 5% albumin
Median number of TPE: 3.5
Chien et al[22]Retrospective case seriesPE, No comparative armPlasma exchange volume: Plasma exchange was usually performed daily for the first 3 d, and then shifted to every other day or every 3 d according to the patient's condition60% idiopathic, 17% infection, 8% metabolic and immunologic, 4% toxin11 (48%) had native liver recovery (NLR), 9 (39.1%) died without liver transplant, and 3 (12.9%) received liver transplantation
The no liver recovery group showed a lower proportion of idiopathic cases, lower peak ammonia level, higher peak alpha fetoprotein (AFP) level, and they had plasma exchange fewer times than the other groups
n = 23
Age 0.29-9.25 yr
Plasma exchange volume: 2–4 times the patient’s estimated plasma volume
Plasma exchange fluid: FFP
Ide et al[47]Retrospective case seriesPE/CVVHDF, No comparative armCVVHDF and PE were applied in all ALF patients2/17 viralAll laboratory results relating to liver dysfunction decreased significantly after CVVHDF + PE
1/17 mitochondrial
PE using 100 mL/kg of FFP per treatment course was implemented once daily for 6 to 8 h until the recovery of coagulopathyOverall survival rate 88% with median follow up period of 28 mo
14/17 indeterminate
n = 17
Age 1-11 mo [Median Weight 8.0 (2.7-10 kg)]
Verma et al[23]Case reportPE, No comparative armPlasma exchange volume: 1.5-2 h, 1.2 L plasma exchange in each session, in addition to oral D penicillamine and ZincWilson’s diseasePatient improved initially but subsequently deteriorated fter developing renal failure and shock, and died from acute pulmonary hemorrhage.
Age 5 yr (Weight: 15 kg)
Morgan et al[25]Case reportPE, No comparative armPlasma exchange volume: 1500 mL TPE, 5 single plasma volume over 11 d in addition to trientineWilson’s diseasePatient had worsening bilirubin, coagulopathy despite treatment and underwent OLT 12 d after beginning TPE
Plasma exchange fluid: PlasmaAge 6 years
Zhang et al[24]Case reportPE, No comparative armPlasma exchange volume: 1200 mL each time, with blood flow velocity of 45–50 mL/min, plasma separation speed of 650–750 mL/h, and a replacement time of approximately 2 h. Total 9 exchangesWilson’s diseaseCPFA started after PE. The patient had rapid recovery of consciousness, removal of copper and stabilization of serum bilirubin and hemoglobin. 9 d after last PE patient underwent liver transplant.
Plasma exchange fluid: FFPAge 7 yr (Weight 21 kg)
Yukselmis et al[26]Case reportPE, No comparative armPlasma exchange volume: 1.5 times total blood volume then 1 time for the subsequent coursesViral (Influenza)Patient did not require transplantation in light of clinical improvement and PE resulted in complete recovery
Total 3 sessions PE on top of ostelmavirAge 4 yr (Weight 16 kg)
Plasma exchange fluid: FFP
Ponikvar et al[27]Case reportPE+HD, No comparative armPlasma exchange volume: 3 volumes of plasma (12% of body weight of 16 kg) per procedure were exchanged (1972 ± 85 mL; range, 1800–2150 mL). FFP was used as the replacement solution. An equal volume of plasma was removed and replacedUnknown Excluded viruses and metabolic causePatient did not improve after 1 mo and was referred to a liver transplant center and successfully transplanted. Patient also had hyperbaric oxygen (HBO) during treatment
Age 3 yr (Weight 16 kg)
A total of 13 PEs, 13 HD sessions, and 9 HBO treatments over a period of 1mo. The initial 4 PEs were followed by HD sessions while the other 8 PE treatments were given simultaneously with HD. There was no renal failure; HD was instituted to improve ammonia elimination
Harmanci et al[48]Case report / Letter to editorPE, No comparative armPlasma exchange volume: 2.5 L per sessionWilson’s DiseasePatients mental status improved and was extubated and weaned from mechanical ventilation on the fifth day of hospitalization. The patient did not require liver transplantation. The patient was treated continously with zinc and D-penicillamine
Age 17 yr
Started daily and continued for 7 consecutive days