High-Volume Plasmapheresis in Children With Acute Liver Fail
Paediatric acute liver failure (P-ALF) is a rare condition and is associated with a high mortality rate. Management of P-ALF aims to stabilise vital organ functions and to remove circulating toxins and provide vital plasma factors that are lacking. High-volume plasmapheresis (HVP) removes protein-bound substances and improves survival in adult ALF. The aim of this study is to report the safety and feasibility of HVP in P-ALF.

Children with P-ALF were offered HVP if bilirubin was higher than 200 ?mol/L or if the aetiology was toxic hepatitis. HVP was performed with fresh frozen plasma corresponding to 10% of the body weight on a minimum of 3 consecutive days. Diagnostics, biochemical and clinical data during HVP as well as outcome data after 3 months were collected and retrospectively analysed.

Results:
--16 children were treated by HVP and completed at least one series of 3 treatment sessions with HVP.

--The only complication seen was an increase in pH more than 7.55 in 3 children within the first 12 hours and was corrected with hydrochloric acid.

--No bleeding or septic episodes were noted during HVP. Eight children survived without liver transplantation, two survived after successful grafting and a total of 6 children died.

--The liver injury unit score between survivors with their own liver and the rest, the two groups was significantly different.

In conclusion, HVP with fresh frozen plasma in children with P-ALF is feasible and well tolerated. There were no significant adverse events or procedure-related deaths reported.

Source: https://journals.lww.com/jpgn/Abstract/2021/06000/Safety_of_High_Volume_Plasmapheresis_in_Children.8.aspx
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