Effects of therapeutic plasma exchange on early allograft dysfunction after liver transplantation.
BACKGROUND
Early allograft dysfunction (EAD) is a serious complication of liver transplantation (LT) and is associated with graft failure, which can result in patient mortality. Due to the shortage of organs for retransplantation, only a small proportion of EAD patients undergo retransplantation. Thus, liver support is needed for most patients with EAD.


METHODS
We evaluated the effects of therapeutic plasma exchange (TPE) in EAD patients. EAD was defined as a sustained hyperbilirubinemia (≥10 mg/dL) within 30 days of LT without concurrent biliary complications. In a 13-year period, 107 EAD patients underwent TPE while 36 EAD patients did not. We investigated the laboratory and clinical outcomes of TPE and non-TPE groups.


RESULTS
The TPE group showed 1-month and 1-year survival rates of 82.2% and 53.8%, respectively, whereas the non-TPE group showed 58.3% and 22.2%, respectively. In TPE group, statistically significant decreases (P < 0.05) in total bilirubin (15.2 ± 5.2 to 13.1 ± 5.4 mg/dL), and INR (1.72 ± 1.04 to 1.38 ± 1.14), were seen after the final TPE session. TPE responder groups with age <51 years, total bilirubin <11.1 mg/dL, or INR <1.15 after final TPE showed better prognosis. TPE decreased the hazard risk of death in EAD patients whereas older age, male gender, and higher INR on the day of EAD onset increased the risk.


CONCLUSIONS
TPE effectively removed plasma bilirubin and improved coagulation function in EAD patients, with higher survival in the TPE group than in the non-TPE group. TPE may be an effective liver support for EAD patients. J. Clin. Apheresis 32:147-153, 2017. © 2016 Wiley Periodicals, Inc.
Department of Laboratory Medicine, Eulji University School of Medicine, Seoul, Korea.|Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Wonho
W
Choe
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Seog-Woon
SW
Kwon
Departmnt of Healthcare Management, Cheongju University College of Health Science, Cheongju, Korea.
Sung-Soo
SS
Kim
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Shin
S
Hwang
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Gi-Won
GW
Song
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Sung-Gyu
SG
Lee
D000328:Adult; D064591:Allografts / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome
graft dysfunction; liver support; liver transplantation; plasma exchange