Peripheral Venous Access for Low-Volume Centrifugal Plasma Exchange to Treat Patients With Liver Disorders.

BACKGROUND/AIMS: Centrifugal plasma exchange (PLEX), by virtue of low blood flow rates, can be performed via peripheral venous access. This study aims to assess the utilization, safety, and efficiency of low-volume centrifugal plasma exchange via peripheral venous access (P-PLEX) in liver disease patients.

METHODS

This retrospective cohort study compared patients with liver disease who underwent low-volume centrifugal P-PLEX (2019-2024) with syndrome-matched patients who underwent plasma exchange via central venous access (C-PLEX). Data on PLEX procedure, venous access, and extraction efficiency for molecules of interest were noted.

RESULTS

Of 448 liver disease patients who underwent centrifugal low-volume PLEX, 81 patients (18.1%) who underwent P-PLEX (M: 60; age: 37 [29.5-46.5] years; median, interquartile range) were compared with 81 syndrome-matched patients who underwent C-PLEX (M: 62; age: 37 [29.5-46.5] years; acute-on-chronic liver failure: 44, acute liver injury/acute liver failure: 21, others: 20). Targeted P-PLEX sessions were completed in 67 of 81 (82%). P-PLEX access was mostly 18-G (n = 64/72 for inlet/return) in antecubital fossa. Thirteen of 81 (16%) P-PLEX patients required access change to C-PLEX. Procedure time was longer in P-PLEX group (105 [82.5-120] min) than in the C-PLEX group (75 [60-91.3] min, P value< 0.001) due to lower flow rates in P-PLEX. When controlled for exchange volumes and baseline values, extraction efficiency of bilirubin (P-PLEX: 34.3% [21.2-42.6], C-PLEX: 27.1% [10.3-41.7]; P value: 0.14) and von Willebrand factor antigen (P-PLEX: 36.1% [21.8-46.8], C-PLEX: 45.6% [32.8-58.3]; P value: 0.19) were similar in both groups. PLEX was performed in the ward (in high monitoring area) in majority of patients in the P-PLEX group (73 [90.1%]) and in the high-dependency unit (43 [53.1%]) in the C-PLEX group. Lower line-related complications with P-PLEX (2/81) vis-à-vis C-PLEX (9/81, P-value: 0.03) were noted.

CONCLUSION

In this report, low-volume centrifugal PLEX to treat liver disease was performed via peripheral venous access in 18% of patients. P-PLEX was done in the ward, with similar efficiency and better line-related safety; however, the PLEX duration was prolonged by 30 min.