Exploring role of therapeutic plasma exchange for hepatitis A-related acute liver failure: An Indian multi-center cohort study.
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Janeela Asisha M, Duseja Ajay, Valsan Arun, Shalimar, Mahajan Ramit, Jain Ajay, Kabrawala Mayank, Philip Mathew, Alagammai P L, Kuriakose Ajith C, Sharma Anand, Devadas Krishnadas, Venkatakrishnan L, Taneja Sunil, S Sudhindran, Swaroop Shekhar, Sood Ajit, Sircar Shohini, Parikh Sankalp S, Zacharias Prakash, Amarnath Domakuntala, Geevarghese Suja K, Negi Gita, Premkumar Madhumita, Mohammed Zubair Umer, Agrawal Samagra, Kumar Rajesh, Jain Alka, Remakanth Remi, Verma Nipun, Paul Zachariah, Biswas Sagnik, Gautam Parshotam Lal, De Arka, Nair Gowripriya, Singh Arshdeep, Malvi Mustafa, Vinod Ashwin Pachat, Sharma Ratti Ram, Hans Rekha, Lamba Divjot Singh, Balaji Vijay, Daniel Dolly, Zachariah Uday George, Goel Ashish, Singal Ashwani K, Eapen C E
Аннотация
METHODS: We retrospectively compared consecutive HAV-ALF patients treated with PLEX (2018-2024) vs. SMT (2011-2024) at 13 centers across India. We compared in-hospital native liver survival in both groups. In the subset of patients not on inotropes, we compared survival and assessed predictors of poor outcome in PLEX and SMT groups.
RESULTS: Eighty-four HAV-ALF patients in PLEX group (61 males; age = 23.5 [21-33] years, median [IQR]; King's College Criteria [KCC] fulfilled = 22 patients, 26.2%) and 150 HAV-ALF in SMT group (101 males; 24 [19-32.3] years; KCC fulfilled = 16, 10.7%) were studied. Overall survival was comparable in PLEX (70.2%) and SMT groups (65.3%) (p-value = 0.47). In a sub-group of hemodynamically stable patients not on inotropes, univariate analysis showed better survival in PLEX group (52/54, 96.3%) as compared to SMT group (81/104, 77.9%; OR = 0.135, 95% CI = 0.03-0.6; p-value = 0.002). However, this benefit was not noted in propensity score matched/regression analyses.
CONCLUSION: While PLEX did not influence in-hospital outcome across all HAV-ALF patients, it may confer survival benefit in a sub-group who remained hemodynamically stable not requiring inotropes. Studies with larger patient numbers are needed to explore this hypothesis.