Impact of plasma adsorption volumes (5 L vs. 6 L) on the prognosis of patients with liver failure.
Impacto de los volúmenes de adsorción plasmática (5 L vs. 6 L) en el pronóstico de pacientes con insuficiencia hepática.
Keywords:
Plasma Adsorption, Liver Failure, Complications, Duration of Therapy, Blood Platelets
Abstract
Plasma adsorption (PA) is used to improve outcomes in liver fail- ure (LF). Data on adsorption capacity and its relationship to patient outcomes are limited. This single-center retrospective study included patients with LF who received PA at the First Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou City, China, between October 2020 and October 2022, and examined the impact of adsorption volume (5 L vs. 6 L) on prognosis. The study included 230 PA treatments, of which nine were excluded due to missing data. The 5L column was used in 60 patients (118 treatments, 47 male), and the 6L column was used in 50 patients (103 treatments, 31 male). Treatment effectiveness was evaluated using length of hospital stay, liver transplantation, death, and improvement in disease-related symptoms. In both groups, PA increased white blood cells (WBC), international normalized ratio (INR), activated partial thromboplastin time (APTT), and prothrombin time (PT) but decreased hemoglobin, total bile acids, total bilirubin, and fibrinogen (all p<0.05). Plate- let levels decreased after 6L PA (p=0.033) but not after 5L PA (p=0.116). After PA, the 6L group had lower WBC than the 5L group (p=0.003), but there were no significant differences in the other parameters. The 5L and 6L columns did not differ significantly in hospital stay duration, liver transplantation, mortality, or symptom improvement. However, the 5L column significantly reduced platelet destruction, shortened treatment time, and reduced the occurrence of complications, particularly thrombocytopenia-related risks. Hence, the results indicate that the 5L volume would be preferable clinically.
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References
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Mertens PR, Schönfelder T, Handt S, Kierdorf H, Marschall H, Busch N, et al. Long-term extracorporeal bilirubin elimination: A case report on cascade resin plasmaperfusion. Blood Purif. 1998;16(6):341-348. https://doi.org/10.1159/000014354.
Thijssen S, Kappel F, Kotanko P. Absolute blood volume in hemodialysis patients: why is it relevant, and how to measure it? Blood Purif. 2013;35(1-3):63-71. https://doi.org/10.1159/000345484.
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Chamuleau RA, Aronson DC, Frederiks WM, Bosman DK, Smit JJ, Maas MA, et al. Liver regeneration after partial hepatectomy in rats with defective bilirubin conjugation or biliary excretion. Dig Dis Sci. 1991;36(4):510-512. https://doi.org/10.1007/BF01298884.
Larsen FS. Artificial liver support in acute and acute-on-chronic liver failure. Curr Opin Crit Care. 2019;25(2):187-191. https://doi.org/10.1097/MCC.0000000000000584.
Che XQ, Li ZQ, Chen Z, Guo D, Jia QY, Jiang SC, 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. https://doi.org/10.26355/eurrev_201802_14400.
Senf R, Klingel R, Kurz S, Tullius S, Sauer I, Frei U, et al. Bilirubin-adsorption in 23 critically ill patients with liver failure. Int J Artif Organs. 2004;27(8):717-722. https://doi.org/10.1177/039139880402700810.
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Giannini EG, Peck-Radosavljevic M. Platelet Dysfunction: Status of Thrombopoietin in Thrombocytopenia Associated with Chronic Liver Failure. Semin Thromb Hemost. 2015;41(5):455-461. https://doi.org/10.1055/s-0035-1550432.
Fathi M. Heparin-induced thrombocytopenia (HIT): Identification and treatment pathways. Glob Cardiol Sci Pract. 2018;2018(2):15. https://doi.org/10.21542/gcsp.2018.15.
Khan MTA, Patnaik R, Huang JY, Campi HD, Montorfano L, De Stefano F, et al. Leukopenia is an independent risk factor for early postoperative complications following incision and drainage of anorectal abscess. Colorectal Dis. 2023;25(4):717-727. https://doi.org/10.1111/codi.16447.
Angeli P, Rodríguez E, Piano S, Ariza X, Morando F, Solà E, et al. Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis. Gut. 2015;64(10):1616-1622. https://doi.org/10.1136/gutjnl-2014-307526.
Lee JY, Kim SB, Chang JW, Park SK, Kwon SW, Song KW, et al. Comparison of the molecular adsorbent recirculating system and plasmapheresis for patients with graft dysfunction after liver transplantation. Transplant Proc. 2010;42(7):2625-2630. https://doi.org/10.1016/j.transproceed.2010.04.070.
European Association for the Study of the Liver, Electronic address eee, Clinical practice guidelines panel, Wendon J, Panel members, Cordoba J, et al. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017;66(5):1047-1081. https://doi.org/10.1016/j.jhep.2016.12.003.
Alarabi AA, Wikstrom B, Loof L, Danielson BG. Treatment of pruritus in cholestatic jaundice by bilirubin- and bile acid-adsorbing resin column plasma perfusion. Scand J Gastroenterol. 1992;27(3):223-226. https://doi.org/10.3109/00365529208999953.
Mandiga P, Kommu S, Foris LA, Bollu PC. Hepatic Encephalopathy. In: StatPearls. Treasure Island (FL); StatPearls Publishing; 2026. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430869/
Francoz C, Durand F, Kahn JA, Genyk YS, Nadim MK. Hepatorenal Syndrome. Clin J Am Soc Nephrol. 2019;14(5):774-781. https://doi.org/10.2215/CJN.12451018.
Viggiano D, de Pascale E, Marinelli G, Pluvio C. A comparison among three different apheretic techniques for treatment of hyperbilirubinemia. J Artif Organs. 2018;21(1):110-116. https://doi.org/10.1007/s10047-017-0986-1.
Fuhrmann V, Horvatits T, Drolz A, Rutter K. [Extracorporeal therapy of patients with liver disease in the intensive care unit]. Med Klin Intensivmed Notfmed. 2014;109(4):246-251. https://doi.org/10.1007/s00063-013-0321-4.
Saliba F, Bañares R, Larsen FS, Wilmer A, Parés A, Mitzner S, et al. Artificial liver support in patients with liver failure: a modified DELPHI consensus of international experts. Intensive Care Med. 2022;48(10):1352-1367, https://doi.org/10.1007/s00134-022-06802-1.
Sun Y, Yu LX, Liu YH, Wang B, Lu W. [Bilirubin adsorption therapy for two infants with liver failure]. Zhonghua Er Ke Za Zhi. 2020;58(11):933-934. https://doi.org/10.3760/cma.j.cn112140-20200411-00376.
Tsipotis E, Shuja A, Jaber BL. Albumin Dialysis for Liver Failure: A Systematic Review. Adv Chronic Kidney Dis. 2015;22(5):382-390. https://doi.org/10.1053/j.ackd.2015.05.004.
Adani GL, Lorenzin D, Currò G, Sainz-Barriga M, Comuzzi C, Bresadola V, et al. Selective bilirubin removal by plasma treatment with Plasorba BR-350 for early cholestatic graft dysfunction. Transplant Proc. 2007;39(6):1904-1906. https://doi.org/10.1016/j.transproceed.2007.05.010.
Geiger H, Klepper J, Lux P, Heidland A. Biochemical assessment and clinical evaluation of a bilirubin adsorbent column (BR-350) in critically ill patients with intractable jaundice. Int J Artif Organs. 1992;15(1):35-39. PMID: 1551726.
Borberg H. Comparison of different Lp (a) elimination techniques: a retrospective evaluation. Transfus Apher Sci. 2009;41(1):61-65. https://doi.org/10.1016/j.transci.2009.05.014.
Ihara H, Shino Y, Hashizume N, Aoki T, Suzuki Y, Igarasi Y, et al. Decline in plasma retinol in unconjugated hyperbilirubinemia treated with bilirubin adsorption using an anion-exchange resin. J Nutr Sci Vitaminol (Tokyo). 1998;44(2):329-336. https://doi.org/10.3177/jnso.44.329.
Ryan CJ, Anilkumar T, Ben-Hamida AJ, Khorsandi SE, Aslam M, Pusey CD, et al. Multisorbent plasma perfusion in fulminant hepatic failure: effects of duration and frequency of treatment in rats with grade III hepatic coma. Artif Organs. 2001;25(2):109-118. https://doi.org/10.1046/j.1525-1594.2001.025002109.x.
Mertens PR, Schönfelder T, Handt S, Kierdorf H, Marschall H, Busch N, et al. Long-term extracorporeal bilirubin elimination: A case report on cascade resin plasmaperfusion. Blood Purif. 1998;16(6):341-348. https://doi.org/10.1159/000014354.
Thijssen S, Kappel F, Kotanko P. Absolute blood volume in hemodialysis patients: why is it relevant, and how to measure it? Blood Purif. 2013;35(1-3):63-71. https://doi.org/10.1159/000345484.
Nafisi VR, Eghbal M. Optimized Blood Volume Monitoring during Hemodialysis Procedure based on Ultrasonic Speed Measurement. J Biomed Phys Eng. 2019;9(3):373-380. https://doi.org/10.31661/jbpe.v9i3.Jun.675.
Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association, Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. [Guideline for diagnosis and treatment of liver failure (2018)]. Zhonghua Gan Zang Bing Za Zhi. 2019;27(1):18-26. https://doi.org/10.3760/cma.j.issn.1007-3418.2019.01.006.
Kaplan AA. A simple and accurate method for prescribing plasma exchange. ASAIO Trans. 1990;36(3):M597-599. PMID: 2252761.
Liang C, Takahashi K, Furuya K, Oda T, Ohkohchi N. Platelets Stimulate Liver Regeneration in a Rat Model of Partial Liver Transplantation. Liver Transpl. 2021;27(5):719-734. https://doi.org/10.1002/lt.25962.
Chamuleau RA, Aronson DC, Frederiks WM, Bosman DK, Smit JJ, Maas MA, et al. Liver regeneration after partial hepatectomy in rats with defective bilirubin conjugation or biliary excretion. Dig Dis Sci. 1991;36(4):510-512. https://doi.org/10.1007/BF01298884.
Larsen FS. Artificial liver support in acute and acute-on-chronic liver failure. Curr Opin Crit Care. 2019;25(2):187-191. https://doi.org/10.1097/MCC.0000000000000584.
Che XQ, Li ZQ, Chen Z, Guo D, Jia QY, Jiang SC, 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. https://doi.org/10.26355/eurrev_201802_14400.
Senf R, Klingel R, Kurz S, Tullius S, Sauer I, Frei U, et al. Bilirubin-adsorption in 23 critically ill patients with liver failure. Int J Artif Organs. 2004;27(8):717-722. https://doi.org/10.1177/039139880402700810.
Schwanke AA, Danski MTR, Pontes L, Kusma SZ, Lind J. Central venous catheter for hemodialysis: incidence of infection and risk factors. Rev Bras Enferm. 2018;71(3):1115-1121. https://doi.org/10.1590/0034-7167-2017-0047.
Daugirdas JT, Bernardo AA. Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia. Kidney Int. 2012;82(2):147-157. https://doi.org/10.1038/ki.2012.130.
Doi Y, Koga K, Sugioka S, Inoue Y, Arisato T, Nishioka K, et al. Heparin-induced thrombocytopenia among incident hemodialysis patients anticoagulated with low molecular weight heparin: A single-center retrospective study. Nefrologia (Engl Ed). 2021;41(3):356-358. https://doi.org/10.1016/j.nefroe.2020.05.007.
Hakim RM, Schafer AI. Hemodialysis-associated platelet activation and thrombocytopenia. Am J Med. 1985;78(4):575-580. https://doi.org/10.1016/0002-9343(85)90398-5.
Giannini EG, Peck-Radosavljevic M. Platelet Dysfunction: Status of Thrombopoietin in Thrombocytopenia Associated with Chronic Liver Failure. Semin Thromb Hemost. 2015;41(5):455-461. https://doi.org/10.1055/s-0035-1550432.
Fathi M. Heparin-induced thrombocytopenia (HIT): Identification and treatment pathways. Glob Cardiol Sci Pract. 2018;2018(2):15. https://doi.org/10.21542/gcsp.2018.15.
Khan MTA, Patnaik R, Huang JY, Campi HD, Montorfano L, De Stefano F, et al. Leukopenia is an independent risk factor for early postoperative complications following incision and drainage of anorectal abscess. Colorectal Dis. 2023;25(4):717-727. https://doi.org/10.1111/codi.16447.
Published
2026-05-31
How to Cite
Zhang, X., Zhang, Z., Chen , H., & Zhang, H. (2026). Impact of plasma adsorption volumes (5 L vs. 6 L) on the prognosis of patients with liver failure.: Impacto de los volúmenes de adsorción plasmática (5 L vs. 6 L) en el pronóstico de pacientes con insuficiencia hepática. Investigación Clínica, 67(2), 230-240. https://doi.org/10.54817/IC.v67n2a06
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