Efficacy and safety of plasma diafiltration in the treatment of liver failure_West China Medical Journal

Authors：

DAI Mingjin ¹ , ZHAO Yuan ¹ , WANG Fang ¹ , CHEN Zhiwen ¹ ,  YANG Yingying ¹ , MA Yuanji ² , ZHANG Ling ¹ , FU Ping ¹

1. Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

YANG Yingying, Email: yingyingyangsf@163.com

Keywords：

Plasma diafiltration; liver failure; double plasma molecular adsorption system; plasma exchange

DOI：

10.7507/1002-0179.202306197

Video：

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Objective To explore the safety and efficacy of plasma diafiltration (PDF) in the treatment of liver failure. Methods Patients with liver failure requiring artificial liver treatment in West China Hospital of Sichuan University from December 2020 to December 2022 were selected and divided into three groups according to treatment modality: PDF group, double plasma molecular adsorption system (DPMAS) group and plasma exchange (PE) group. Serum albumin levels and total bilirubin (TB) levels were tested before and after treatments to compare the clearance of these substances among three groups. Adverse events were recorded. Results A total of 88 patients were included, with a total of 179 treatments conducted. Among them, 27 cases in PDF group were treated for 62 times. In PE group, 18 cases were treated for 33 times. In DPMAS group, 43 cases were treated for 84 times. There were no significant differences between the three groups in age, sex, TB, international standardized ratio, albumin, hemoglobin, blood pH value, blood sodium, blood potassium, blood free calcium, or lactate (P>0.05). There was no statistically significant difference in the absolute value of TB decrease, percentage of TB decrease, absolute value of albumin change, and percentage of albumin change before and after treatment among the three groups (P>0.05). Transient hypotension occurred in one patient in DPMAS group. There were two and three allergic reactions in PDF and PE groups, respectively. In addition, 2 patients in PE group had hypocalcemia. Conclusions PDF can be safely used in patients with liver failure, and its therapeutic effect on reducing bilirubin is similar to DPMAS and PE groups. Compared with PE, it needs less plasma supplement. As it can provide ultrafiltration, PDF would be helpful in patients with liver failure accompanied by renal insufficiency oliguria.

Citation： DAI Mingjin, ZHAO Yuan, WANG Fang, CHEN Zhiwen, YANG Yingying, MA Yuanji, ZHANG Ling, FU Ping. Efficacy and safety of plasma diafiltration in the treatment of liver failure. West China Medical Journal, 2024, 39(7): 1063-1067. doi: 10.7507/1002-0179.202306197 Copy

1.	中華醫學會感染病學分會肝衰竭與人工肝學組, 中華醫學會肝病學分會重型肝病與人工肝學組, 肝衰竭診治指南(2018 年版). 臨床肝膽病雜志, 2019, 35(1): 38-44.
2.	中華醫學會感染病學分會肝衰竭與人工肝學組. 非生物型人工肝治療肝衰竭指南(2016 年版). 中華臨床感染病雜志, 2016, 9(2): 97-103.
3.	Yang L, Wu T, Li J, et al. Artificial liver treatment improves survival in patients with hepatitis B virus‐related acute‐on‐chronic liver failure: a case‐control matched analysis. Hepatol Res, 2020, 50(6): 656-670.
4.	Xiao LL, Xu XW, Huang KZ, et al. Artificial liver support system improves short-term outcomes of patients with HBV-associated acute-on-chronic liver failure: a propensity score analysis. Biomed Res Int, 2019: 3757149.
5.	Chen JJ, Huang JR, 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(3): 275-281.
6.	Qin G, Shao JG, Wang B, et al. Artificial liver support system improves short- and long-term outcomes of patients with HBV-associated acute-on-chronic liver failure: a single-center experience. Medicine (Baltimore), 2014, 93(28): e338.
7.	Mori T, Eguchi Y, Shimizu T, et al. A case of acute hepatic insufficiency treated with novel plasmapheresis plasma diafiltration for bridge use until liver transplantation. Ther Apher, 2002, 6(6): 463-466.
8.	崔嵩, 晁嬌嬌, 周恒杰, 等. 血漿透析濾過技術治療肝功能衰竭療效分析. 醫學理論與實踐, 2019, 32(6): 788-790, 810.
9.	中華醫學會肝病學分會重型肝病與人工肝學組. 人工肝血液凈化技術臨床應用專家共識(2022 年版). 臨床肝膽病雜志, 2022, 38(4): 767-775.
10.	程芝靈, 孫桂香, 林輝, 等. 血漿置換治療肝衰竭臨床療效和安全性的 Meta 分析. 中國循證醫學雜志, 2015, 15(6): 664-671.
11.	Francoz C, Durand F, Kahn JA, et al. Hepatorenal syndrome. Clin J Am Soc Nephrol, 2019, 14(5): 774-781.
12.	Best LM, Freeman SC, Sutton AJ, et al. Treatment for hepatorenal syndrome in people with decompensated liver cirrhosis: a network meta-analysis. Cochrane Database Syst Rev, 2019, 9(9): CD013103.
13.	Che XQ, Li ZQ, Chen Z, et al. Plasma exchange combining with plasma bilirubin adsorption effectively removes toxic substances and improves liver functions of hepatic failure patients. Eur Rev Med Pharmacol Sci, 2018, 22(4): 1118-1125.
14.	四川大學華西醫院. 非生物型人工肝設備與技術專家共識. 中國醫學裝備, 2023, 20(3): 176-185.
15.	Tsipotis E, Shuja A, Jaber BL. Albumin dialysis for liver failure: a systematic review. Adv Chronic Kidney Dis, 2015, 22(5): 382-390.
16.	Nakae H, Igarashi T, Tajimi K, et al. A case report of hepatorenal syndrome treated with plasma diafiltration (selective plasma filtration with dialysis). Ther Apher Dial, 2007, 11(5): 391-395.
17.	Nakae H, Igarashi T, Tajimi K, et al. A case report of pediatric fulminant hepatitis treated with plasma diafiltration. Ther Apher Dial, 2008, 12(4): 329-332.
18.	Nakae H, Eguchi Y, Saotome T, et al. Multicenter study of plasma diafiltration in patients with acute liver failure. Ther Apher Dial, 2010, 14(5): 444-450.
19.	Hayashi H, Takamura H, Taniguchi T, et al. A case of living donor liver transplant recipient treated with novel blood purification “plasma diafiltration”. Int Surg, 2013, 98(4): 428-431.
20.	Komura T, Taniguchi T, Sakai Y, et al. Efficacy of continuous plasma diafiltration therapy in critical patients with acute liver failure. J Gastroenterol Hepatol, 2014, 29(4): 782-786.
21.	Shimizu M, Nakayama Y, Taniguchi T. Successful treatment of enterohemorrhagic Escherichia coli O111-induced acute encephalopathy and hemolytic-uremic syndrome with plasma diafiltration. Ther Apher Dial, 2014, 18(5): 516-518.
22.	劉宏宇, 趙秀寶, 劉偉, 等. 血漿置換聯合血液透析濾過治療產后溶血尿毒綜合征三例療效分析. 國際婦產科學雜志, 2021, 48(3): 264-267.
23.	Lv R, Yu X, Zeng W, et al. Treatment of hypertriglyceridemia-induced acute pancreatitis with plasma diafiltration: a pilot study. Pancreas, 2020, 49(10): e103-e105.
24.	Inoue N, Sato A, Ikawa Y, et al. Successful treatment of exertional heat stroke using continuous plasma diafiltration. J Clin Apher, 2016, 31(5): 490-492.
25.	林建輝, 陳麗霞, 藍麗琴, 等. 人工肝血漿透析濾過干預啟動時間與乙型肝炎相關性慢加急性肝衰竭患者院內預后之間的關聯. 中國血液凈化, 2023, 22(3): 221-226.

1. 中華醫學會感染病學分會肝衰竭與人工肝學組, 中華醫學會肝病學分會重型肝病與人工肝學組, 肝衰竭診治指南(2018 年版). 臨床肝膽病雜志, 2019, 35(1): 38-44.
2. 中華醫學會感染病學分會肝衰竭與人工肝學組. 非生物型人工肝治療肝衰竭指南(2016 年版). 中華臨床感染病雜志, 2016, 9(2): 97-103.
3. Yang L, Wu T, Li J, et al. Artificial liver treatment improves survival in patients with hepatitis B virus‐related acute‐on‐chronic liver failure: a case‐control matched analysis. Hepatol Res, 2020, 50(6): 656-670.
4. Xiao LL, Xu XW, Huang KZ, et al. Artificial liver support system improves short-term outcomes of patients with HBV-associated acute-on-chronic liver failure: a propensity score analysis. Biomed Res Int, 2019: 3757149.
5. Chen JJ, Huang JR, 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(3): 275-281.
6. Qin G, Shao JG, Wang B, et al. Artificial liver support system improves short- and long-term outcomes of patients with HBV-associated acute-on-chronic liver failure: a single-center experience. Medicine (Baltimore), 2014, 93(28): e338.
7. Mori T, Eguchi Y, Shimizu T, et al. A case of acute hepatic insufficiency treated with novel plasmapheresis plasma diafiltration for bridge use until liver transplantation. Ther Apher, 2002, 6(6): 463-466.
8. 崔嵩, 晁嬌嬌, 周恒杰, 等. 血漿透析濾過技術治療肝功能衰竭療效分析. 醫學理論與實踐, 2019, 32(6): 788-790, 810.
9. 中華醫學會肝病學分會重型肝病與人工肝學組. 人工肝血液凈化技術臨床應用專家共識(2022 年版). 臨床肝膽病雜志, 2022, 38(4): 767-775.
10. 程芝靈, 孫桂香, 林輝, 等. 血漿置換治療肝衰竭臨床療效和安全性的 Meta 分析. 中國循證醫學雜志, 2015, 15(6): 664-671.
11. Francoz C, Durand F, Kahn JA, et al. Hepatorenal syndrome. Clin J Am Soc Nephrol, 2019, 14(5): 774-781.
12. Best LM, Freeman SC, Sutton AJ, et al. Treatment for hepatorenal syndrome in people with decompensated liver cirrhosis: a network meta-analysis. Cochrane Database Syst Rev, 2019, 9(9): CD013103.
13. Che XQ, Li ZQ, Chen Z, et al. Plasma exchange combining with plasma bilirubin adsorption effectively removes toxic substances and improves liver functions of hepatic failure patients. Eur Rev Med Pharmacol Sci, 2018, 22(4): 1118-1125.
14. 四川大學華西醫院. 非生物型人工肝設備與技術專家共識. 中國醫學裝備, 2023, 20(3): 176-185.
15. Tsipotis E, Shuja A, Jaber BL. Albumin dialysis for liver failure: a systematic review. Adv Chronic Kidney Dis, 2015, 22(5): 382-390.
16. Nakae H, Igarashi T, Tajimi K, et al. A case report of hepatorenal syndrome treated with plasma diafiltration (selective plasma filtration with dialysis). Ther Apher Dial, 2007, 11(5): 391-395.
17. Nakae H, Igarashi T, Tajimi K, et al. A case report of pediatric fulminant hepatitis treated with plasma diafiltration. Ther Apher Dial, 2008, 12(4): 329-332.
18. Nakae H, Eguchi Y, Saotome T, et al. Multicenter study of plasma diafiltration in patients with acute liver failure. Ther Apher Dial, 2010, 14(5): 444-450.
19. Hayashi H, Takamura H, Taniguchi T, et al. A case of living donor liver transplant recipient treated with novel blood purification “plasma diafiltration”. Int Surg, 2013, 98(4): 428-431.
20. Komura T, Taniguchi T, Sakai Y, et al. Efficacy of continuous plasma diafiltration therapy in critical patients with acute liver failure. J Gastroenterol Hepatol, 2014, 29(4): 782-786.
21. Shimizu M, Nakayama Y, Taniguchi T. Successful treatment of enterohemorrhagic Escherichia coli O111-induced acute encephalopathy and hemolytic-uremic syndrome with plasma diafiltration. Ther Apher Dial, 2014, 18(5): 516-518.
22. 劉宏宇, 趙秀寶, 劉偉, 等. 血漿置換聯合血液透析濾過治療產后溶血尿毒綜合征三例療效分析. 國際婦產科學雜志, 2021, 48(3): 264-267.
23. Lv R, Yu X, Zeng W, et al. Treatment of hypertriglyceridemia-induced acute pancreatitis with plasma diafiltration: a pilot study. Pancreas, 2020, 49(10): e103-e105.
24. Inoue N, Sato A, Ikawa Y, et al. Successful treatment of exertional heat stroke using continuous plasma diafiltration. J Clin Apher, 2016, 31(5): 490-492.
25. 林建輝, 陳麗霞, 藍麗琴, 等. 人工肝血漿透析濾過干預啟動時間與乙型肝炎相關性慢加急性肝衰竭患者院內預后之間的關聯. 中國血液凈化, 2023, 22(3): 221-226.

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