A Single Center Retrospective Study: Efficacy and Platelet Preservation of Double Plasma Molecular Adsorption System Therapy by Membrane Separation Versus Centrifugal Separation in Acute-on-Chronic Liver Failure Patients With Hepatocellular Carcinoma.

Hepatitis B virus (HBV) infection is a leading cause of hepatocellular carcinoma (HCC) and liver failure. The double plasma molecular adsorption system (DPMAS) reduces bilirubin and may create a therapeutic window for anti-tumor therapy in HCC patients. Two plasma separation techniques are used: membrane-based (MBS-DPMAS) and centrifugal (CPS-DPMAS), but no study has compared them specifically in HCC patients with acute-on-chronic liver failure (ACLF). This retrospective study included 203 HBV-related HCC patients who received DPMAS without plasma exchange (93 MBS-DPMAS, 110 CPS-DPMAS), with citrate anticoagulation used in all cases. Bilirubin, liver enzymes, INR, and platelet count were compared between groups and before versus after treatment. Baseline characteristics were comparable. CPS-DPMAS showed superior bilirubin reduction (TBIL: 184.60 vs. 220.05 μmol/L, p = 0.002; DBIL: 156.04 vs. 183.55 μmol/L, p = 0.004), whereas platelet count was significantly higher after MBS-DPMAS than after CPS-DPMAS (135.35 vs. 106.32 × 109/L, p = 0.012). Both modalities decreased INR transiently, and only MBS-DPMAS significantly reduced ALT, AST, and creatinine. In conclusion, both techniques effectively reduce bilirubin and decrease INR, but CPS-DPMAS offers better bilirubin clearance while MBS-DPMAS provides better platelet protection, suggesting that technique selection should be individualized.