Turning the Tide of Viral Hepatitis-Induced Acute Liver Failure: The Role of Standard Volume Plasma Exchange in Adults and Children.

Introduction: Therapeutic plasma exchange (TPE) is the most widely used artificial liver support system in liver failure patients.

Cases: We report five cases of viral hepatitis induced ALF 3 adult (case I, II, III) and two pediatric (case IV and V) patients not adequately responding to standard medical treatment (SMT). Case I and II were acute hepatitis B infections while case III was an antenatal case with acute hepatitis E. A standard volume TPE (SV-TPE) was performed, exchanging 1.5 to 2 times the plasma volume in adults and an exchange of 1.5 times the plasma volume was performed in pediatric patients. Post procedure total bilirubin, AST, ALT, PT, and INR, HE, MELD and PELD scores were observed. Patients were classified into rapid and slow responders Results: A mean number of 3.6 sessions were performed for adult and 2.5 sessions for pediatric patients. There was a mean fall of 83%, 63%, 68%, 33% and 33% respectively in total bilirubin, AST, ALT, INR and PT levels after three sessions in adult patients and 35 %, 97%, 96% and 67% and 55% respectively in pediatric patients. HE significantly improved after SV-TPE in case I, III, IV, and V. The MELD score of case I, II and III improved by 39%, 23%, 5%, and PELD score by 68%, 68% in case IV and V respectively. Case I, III and IV were rapid responders while Case II and III were slow responders.

Conclusion: SV-TPE is effective in ALF due to viral etiology in both adults and children. It further emphasizes on an etiology based evaluation of SV-TPE in adults pediatric population to derive a common consensus regarding patient selection, time of initiation, plasma volume to be exchanged, number of sessions, intervals and end points.