Early therapeutic plasma exchange may improve treatment outcomes in severe acute toxic Hepatitis

Ilhami Berber; Yasir Furkan Cagin; Mehmet Ali Erdogan; Engin Ataman; Harika Gozukara; Mehmet Ali Erkurt; Oguzhan Yildirim; İrfan Kuku; Emin Kaya; Yilmaz Bilgic; Ahmet Sarici; Soykan Bicim; Alaadin Polat

doi:10.1016/j.transci.2021.103250

Early therapeutic plasma exchange may improve treatment outcomes in severe acute toxic Hepatitis

Transfus Apher Sci. 2021 Oct;60(5):103250. doi: 10.1016/j.transci.2021.103250. Epub 2021 Aug 17.

Authors

Affiliations

¹ Inonu University, Faculty of Medicine, Department of Hematology, Malatya, Turkey.
² Inonu University, Faculty of Medicine, Department of Gastroenterology, Malatya, Turkey. Electronic address: yafur@hotmail.com.
³ Inonu University, Faculty of Medicine, Department of Gastroenterology, Malatya, Turkey.
⁴ Inonu University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Malatya, Turkey.
⁵ Inonu University, Faculty of Medicine, Department of Physiology, Malatya, Turkey.

PMID: 34666895
DOI: 10.1016/j.transci.2021.103250

Abstract

Background and objectives: Acute toxic hepatitis can result in a different clinical course from a completely curable disease to subacute hepatitis, chronic hepatitis, and fulminant hepatitis failure, which is quite mortal. For this purpose, therapeutic plasma exchange (TPE) can be used for improving treatment outcomes by reducing the harmful substances caused with and/or without liver function in acute toxic hepatitis. We aimed to evaluate treatment outcomes in severe acute toxic hepatitis patients who applied early TPE procedure.

Materials and methods: A total of 335 patients who received TPE between 2010-2021 were retrospectively screened and 59 (male/female, 30/29; min/max-age, 22-84) patients with acute toxic hepatitis who underwent TPE in the first 24 h were included in the study. TPE was performed in patients who had high total bilirubin level (>10 mg/dL). Laboratory parameters of the patients before and after the TPE procedure, number of patients developed complications of acute toxic hepatitis and mortality rates were evaluated for effectiveness of TPE.

Results: Acute toxic hepatitis was associated with hepatotoxic drugs in 44 (74.5 %), herbal medication 6 (10.2 %), mushroom poisoning 6 (10.2 %) and with substance abuse 3 (5.1 %) in patients. When the patients were compared based on INR, liver function tests, ammonia, lactate and Model For End-Stage Liver Disease (MELD) score at baseline, 48 h after TPE (independently of TPE number) and before final state a statistically significant decrease was observed in all parameters (p < 0.05). Fifty three (90 %) of patients improved without complications, the remaining 6 (10 %) patients were diagnosed with fulminant hepatitis. All these remaining patients died before liver transplantation (LTx) could be performed.

Conclusion: TPE is a safe, tolerable therapy option and early TPE may improve treatment outcomes in severe acute toxic hepatitis.

Keywords: Fulminant liver failure; Severe acute toxic hepatitis; Therapeutic plasma exchange.

MeSH terms

Acute Disease
Female
Hepatitis / therapy*
Humans
Male
Plasma Exchange / methods*
Retrospective Studies
Treatment Outcome