Therapeutic plasma exchange in children with acute liver failure: assessment of laboratory parameters

Introduction

The aim of this study is to analyze the effect of therapeutic plasma exchange (TPE) on biochemical and coagulation parameters.

Methods

We enrolled all children who were admitted to the pediatric ICU with diagnosis of acute liver failure and underwent TPE between December 2005 and December 2009. Serum prothrombin time, International Normalized Ratio, total and direct bilirubin, aminotransferases and serum ammonia values were recorded before and after TPE sessions.

Results

Fourteen patients (male/female, 4/10, median age 8.5 years) underwent a total of 37 TPE sessions. Acute liver failure was induced by viral hepatitis in five cases, Wilson disease in four cases, toxins in four cases and autoimmune hepatitis in one case. When compared with baseline, there were significant improvements in laboratory parameters (Table 1). Five of the 14 patients (35.7%) died in the pediatric ICU, five patients underwent liver transplantation. Four patients (28.5%) survived with extracorporeal liver support. No serious adverse effect of TPE was observed in the patients during or after completion of TPE.

Table 1 Biochemical and coagulation parameters before and after TPE

Conclusions

TPE is effective in improving liver biochemistry tests in children with liver failure. Expected changes in laboratory parameters after TPE must be considered especially in deciding for liver transplantation.