title: Role of plasmapheresis in the management of acute hepatic failure in children.
abstract: OBJECTIVE
  To assess the efficacy of plasmapheresis in the treatment of children with acute hepatic failure.
  
  
  BACKGROUND
  Acute liver failure is expressed with severe encephalopathy, coagulopathy, and subsequent multisystem organ failure, resulting in a high death rate. Liver transplantation is considered the best option, with long-term 1-year survival rates exceeding 88%. It has been suggested that plasmapheresis may improve coagulopathy and prevent bleeding complications while maintaining adequate fluid, electrolyte, and acid-base balance.
  
  
  METHODS
  Forty-nine patients with acute liver failure underwent a total of 243 therapeutic plasma exchanges (TPE). Indications for treatment included candidacy for liver transplant and prolonged prothrombin time. Pheresis was performed daily until the patient recovered, died, or was transplanted. Four patients were anhepatic during pheresis.
  
  
  RESULTS
  Coagulation profiles after TPE significantly improved compared with mean preexchange values while maintaining euvolemia. No bleeding episodes were observed during the course of treatment. There was no sustained improvement in neurologic function. Spontaneous recovery was observed in three patients; the remaining either underwent transplantation (32/49) or were not considered transplant candidates because of irreversible neurologic insults (11/49) or sepsis (3/49).
  
  
  CONCLUSIONS
  For children with acute liver failure, TPE is extremely effective in preventing life-threatening bleeding while maintaining appropriate volume status in small children. This method of treatment has no effect on the neurologic complications of liver failure and has no impact on the ability of the liver to regenerate.
authors.affiliation: Fred and Suzanne Biesecker Center for Pediatric Liver Disease, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Singer
authors.forename: K M
authors.initials: KM
authors.lastname: Olthoff
authors.forename: H
authors.initials: H
authors.lastname: Kim
authors.forename: E
authors.initials: E
authors.lastname: Rand
authors.forename: G
authors.initials: G
authors.lastname: Zamir
authors.forename: A
authors.initials: A
authors.lastname: Shaked
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006501:Hepatic Encephalopathy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017093:Liver Failure / Q000628:therapy*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D010951:Plasma Exchange; D010956:Plasmapheresis / Q000009:adverse effects; D016896:Treatment Outcome