Skip to main content
SpringerLink
Log in

Plasma perfusion combined with plasma exchange in chronic hepatitis B-related acute-on-chronic liver failure patients

  • Original Article
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Background and aims

Artificial liver support systems (ALSS) have been shown to significantly reduce mortality in patients with acute-on-chronic liver failure (ACLF). However, the characteristics of patients who would benefit most from ALSS treatment are poorly understood. This study aimed to delineate the indicators for ALSS and evaluate the effectiveness of plasma perfusion combined with plasma exchange (PP + PE) in patients with hepatitis B virus-related ACLF (HBV-ACLF).

Methods

A total of 898 patients with HBV-ACLF in a single center were enrolled retrospectively. Propensity score matching (PSM) was used in case-paired analysis. Hepatic or extra-hepatic organ failures were defined by Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) criteria. Complications included ascites, infection, hepatopulmonary syndrome, hepatorenal syndrome, hepatic encephalopathy and upper gastrointestinal bleeding. Numbers of organ failures or complications were used for risk stratification.

Results

Among all patients, 418 patients received standard medical therapy (SMT) and 480 received PP + PE plus SMT. After one-to-one paired PSM within the two groups without risk stratification, 293 pairs were enrolled. The PP + PE group displayed significantly lower mortality risk in both 28- and 90-day observation durations. When stratified, patients with two or more organ failures or complications from the PP + PE group showed greater decrease in mortality risk. Moreover, PP + PE treatment significantly increased the resolution of organ failures and complications and ameliorated the development of new organ failures and complications.

Conclusions

PP + PE treatment significantly reversed organ failures and ameliorated the development of new organ failures and complications, thus reducing mortality risk of patients with HBV-ACLF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

AARC:

Asian Pacific Association for the Study of Liver (APASL) ACLF Research Consortium

ACLF:

Acute-on-chronic liver failure

HBV:

Hepatitis B virus

TPPMs:

Tongji prognostic predictor model score

COSSH-ACLFs:

Chinese Group on the Study of Severe Hepatitis B-ACLF score

CLIF-C:

Chronic Liver Failure Consortium

OFs:

Organ failure score

MELDs:

Model for End-stage Liver Disease score

Nas:

Sodium score

References

  1. Sarin SK, Choudhury A, Sharma MK, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update. Hepatol Int 2019;13:353–390

    Article  Google Scholar 

  2. Allen AM, Kim WR, Moriarty JP, et al. Time trends in the health care burden and mortality of acute on chronic liver failure in the United States. Hepatology 2016;64:2165–2172

    Article  Google Scholar 

  3. Hernaez R, Sola E, Moreau R, et al. Acute-on-chronic liver failure: an update. Gut 2017;66:541–553

    Article  CAS  Google Scholar 

  4. García Martínez JJ, Bendjelid K. Artificial liver support systems: what is new over the last decade? Ann Intensive Care 2018;8:109

    Article  Google Scholar 

  5. Xu X, Liu X, Ling Q, et al. Artificial liver support system combined with liver transplantation in the treatment of patients with acute-on-chronic liver failure. PLoS One 2013;8:e58738

    Article  CAS  Google Scholar 

  6. Liver Failure and Artificial Liver Group, Branch of Infectious Diseases, Chinese Medical Association. Guideline for non-bioartificial liver support systems in treatment of liver failure: 2016 update. Chin J Clin Infect Dis 2016;2016(9):97–103

    Google Scholar 

  7. Chen T, Yang Z, Choudhury AK, et al. Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia-Pacific region. Hepatol Int 2019;13:695–705

    Article  Google Scholar 

  8. Ma K, Guo W, Han M, et al. Entecavir treatment prevents disease progression in hepatitis B virus-related acute-on-chronic liver failure: establishment of a novel logistical regression model. Hepatol Int 2012;6:735–743

    Article  Google Scholar 

  9. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–710

    Article  CAS  Google Scholar 

  10. Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013;144:1426–1437

    Article  Google Scholar 

  11. Chen J-J, Huang J-R, Yang Q, et al. Plasma exchange-centered artificial liver support system in hepatitis B virus-related acute-on-chronic liver failure: a nationwide prospective multicenter study in China. Hepatobiliary Pancreat Dis Int 2016;15:275–281

    Article  Google Scholar 

  12. Braitman LE, Rosenbaum PR. Rare outcomes, common treatments: analytic strategies using propensity scores. Ann Intern Med 2002;137:693–695

    Article  Google Scholar 

  13. Austin PC. Generating survival times to simulate Cox proportional hazards models with time-varying covariates. Stat Med 2012;31:3946–3958

    Article  Google Scholar 

  14. Beyersmann J, Gastmeier P, Wolkewitz M, et al. An easy mathematical proof showed that time-dependent bias inevitably leads to biased effect estimation. J Clin Epidemiol 2008;61:1216–1221

    Article  Google Scholar 

  15. Gerth HU, Pohlen M, Tholking G, et al. Molecular adsorbent recirculating system can reduce short-term mortality among patients with acute-on-chronic liver failure-a retrospective analysis. Crit Care Med 2017;45:1616–1624

    Article  CAS  Google Scholar 

  16. Banares R, Nevens F, Larsen FS, et al. Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial. Hepatology 2013;57:1153–1162

    Article  CAS  Google Scholar 

  17. Kribben A, Gerken G, Haag S, et al. Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure. Gastroenterology 2012;142:782–789

    Article  CAS  Google Scholar 

  18. Larsen FS, Schmidt LE, Bernsmeier C, et al. High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial. J Hepatol 2016;64:69–78

    Article  Google Scholar 

  19. Alshamsi F, Alshammari K, Belley-Cote E, et al. Extracorporeal liver support in patients with liver failure: a systematic review and meta-analysis of randomized trials. Intensive Care Med 2020;46:1–16

    Article  Google Scholar 

  20. Xia Q, Dai X, Huang J, et al. A single-center experience of non-bioartificial liver support systems among Chinese patients with liver failure. Int J Artif Org 2014;37:442–454

    Article  Google Scholar 

  21. Wu D, Sun Z, Liu X, et al. HINT: a novel prognostic model for patients with hepatitis B virus-related acute-on-chronic liver failure. Aliment Pharmacol Ther 2018;48:750–760

    Article  CAS  Google Scholar 

  22. Liu Z, Meng F, Li C, et al. Human umbilical cord mesenchymal stromal cells rescue mice from acetaminophen-induced acute liver failure. Cytotherapy 2014;16:1207–1219

    Article  CAS  Google Scholar 

  23. Sun K, Xie X, Xie J, et al. Cell-based therapy for acute and chronic liver failures: distinct diseases, different choices. Sci Rep 2014;4:6494

    Article  CAS  Google Scholar 

  24. Liu QW, Liu QY, Li JY, et al. Therapeutic efficiency of human amniotic epithelial stem cell-derived functional hepatocyte-like cells in mice with acute hepatic failure. Stem Cell Res Ther 2018;9:321

    Article  CAS  Google Scholar 

  25. Iansante V, Mitry RR, Filippi C, et al. Human hepatocyte transplantation for liver disease: current status and future perspectives. Pediatr Res. 2018;83:232–240

    Article  CAS  Google Scholar 

  26. Dhawan A, Strom SC, Sokal E, et al. Human hepatocyte transplantation. Methods Mol Biol. 2010;640:525–534

    Article  Google Scholar 

  27. Lin BL, Chen JF, Qiu WH, et al. Allogeneic bone marrow-derived mesenchymal stromal cells for hepatitis B virus-related acute-on-chronic liver failure: A randomized controlled trial. Hepatology. 2017;66:209–219

    Article  CAS  Google Scholar 

  28. Shi M, Zhang Z, Xu R, et al. Human mesenchymal stem cell transfusion is safe and improves liver function in acute-on-chronic liver failure patients. Stem Cells Transl Med. 2012;1:725–731

    Article  CAS  Google Scholar 

  29. Xu WX, He HL, Pan SW, et al. Combination treatments of plasma exchange and umbilical cord-derived mesenchymal stem cell transplantation for patients with hepatitis B virus-related acute-on-chronic liver failure: A clinical trial in China. Stem Cells Int. 2019;2019:4130757

    PubMed  PubMed Central  Google Scholar 

  30. Choudhury A, Jindal A, Maiwall R, et al. Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF): Comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models. Hepatol Int. 2017;11:461–471

    Article  CAS  Google Scholar 

Download references

Funding

This study was funded by the National Thirteenth “Five Years” Project in Science and Technology of China (2017ZX10202201, 2018ZX10302-206).

Author information

Authors and Affiliations

  1. Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, Hubei Province, China

    Zhongyuan Yang, Zhongwei Zhang, Qiuyu Cheng, Guang Chen, Weina Li, Ke Ma, Wei Guo, Tao Chen & Qin Ning

  2. Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China

    Xiaoping Luo

Authors
  1. Zhongyuan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhongwei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qiuyu Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Weina Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ke Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wei Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiaoping Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Qin Ning
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors were involved in critical revision of manuscript. TC and QN contributed to the study conception and design. ZY, ZZ, QC, GC, WL, KM and WG enrolled patients and collected clinical data. ZY analyzed clinical data and drafted the manuscript. XL had contributions to the revision of manuscript in discussion, data re-evaluation and presentation, and manuscript edition. All authors approved the final version of the manuscript, including the authorship list.

Corresponding authors

Correspondence to Tao Chen or Qin Ning.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest about this work.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (the Human Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, China) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed consent

Informed consent was obtained from all individual participants included in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, Z., Zhang, Z., Cheng, Q. et al. Plasma perfusion combined with plasma exchange in chronic hepatitis B-related acute-on-chronic liver failure patients. Hepatol Int 14, 491–502 (2020). https://doi.org/10.1007/s12072-020-10053-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-020-10053-x

Keywords

Search

Navigation