Therapeutic plasma exchange in children with acute liver failure (ALF): is it time for incorporation into the ALF armamentarium?

被引:25
作者
Alexander, Emma C. [1 ]
Deep, Akash [1 ,2 ]
机构
[1] Kings Coll Hosp NHS Fdn Trust, Paediat Intens Care Unit, Denmark Hill, London, England
[2] Kings Coll London, Sch Life Course Sci, Dept Women & Childrens Hlth, London, England
关键词
Plasma exchange; Extracorporeal liver support; Acute liver failure; Paediatric intensive care unit; Children; MANAGEMENT; PLASMAPHERESIS; APHERESIS; GUIDELINES; ETIOLOGY;
D O I
10.1007/s00467-021-05289-0
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Paediatric acute liver failure (PALF) is a rare but devastating condition with high mortality. An exaggerated inflammatory response is now recognised as pivotal in the pathogenesis and prognosis of ALF, with cytokine spill from the liver to systemic circulation implicated in development of multi-organ failure associated with ALF. With advances in medical management, especially critical care, there is an increasing trend towards spontaneous liver regeneration, averting the need for emergency liver transplantation or providing stability to the patient awaiting a graft. Hence, research is ongoing for therapies, including extracorporeal liver support devices, that can bridge patients to transplant or spontaneous liver recovery. Considering the immune-related pathogenesis and inflammatory phenotype of ALF, plasma exchange serves as an ideal liver assist device as it performs both the excretory and synthetic functions of the liver and, in addition, works as an immunomodulatory therapy by suppressing the early innate immune response in ALF. After a recent randomised controlled trial in adults demonstrated a beneficial effect of high-volume plasma exchange on clinical outcomes, this therapy was incorporated in European Association for the Study of Liver (EASL) recommendations for managing adult patients with ALF, but no guidelines exist for PALF. In this review, we discuss rationale, timing, practicalities, and existing evidence regarding the use of plasma exchange as an immunomodulatory treatment in PALF. We discuss controversies in delivery of this therapy as an extracorporeal device, and practicalities of use of plasma exchange as a 'hybrid' therapy alongside other extracorporeal liver assist devices, before finally reviewing outstanding research questions for the future.
引用
收藏
页码:1775 / 1788
页数:14
相关论文
共 49 条
[1]   Hybrid Extracorporeal Therapies as a Bridge to Pediatric Liver Transplantation [J].
Arikan, Ayse Akcan ;
Srivaths, Poyyapakkam ;
Himes, Ryan W. ;
Pekkucuksen, Naile Tufan ;
Lam, Fong ;
Trung Nguyen ;
Miloh, Tamir ;
Braun, Michael ;
Goss, John ;
Desai, Moreshwar S. .
PEDIATRIC CRITICAL CARE MEDICINE, 2018, 19 (07) :E342-E349
[2]   Management of Acute Liver Failure: A Pediatric Perspective [J].
Bhatt H. ;
Rao G.S. .
Current Pediatrics Reports, 2018, 6 (3) :246-257
[3]   Prognostic parameters of pediatric acute liver failure and the role of plasma exchange [J].
Chien, Mu-Ming ;
Chang, Mei-Hwei ;
Chang, Kai-Chi ;
Lu, Fang-Ting ;
Chiu, Yu-Chun ;
Chen, Huey-Ling ;
Ni, Yen-Hsuan ;
Hsu, Hong-Yuan ;
Wu, Jia-Feng .
PEDIATRICS AND NEONATOLOGY, 2019, 60 (04) :389-395
[4]  
Chung Raymond T, 2012, Gastroenterology, V143, pe1, DOI 10.1053/j.gastro.2012.07.011
[5]   Prognostic factors in paediatric acute liver failure [J].
Ciocca, M. ;
Ramonet, M. ;
Cuarterolo, M. ;
Lopez, S. ;
Cernadas, C. ;
Alvarez, F. .
ARCHIVES OF DISEASE IN CHILDHOOD, 2008, 93 (01) :48-51
[6]  
ClinicalTrials.gov, 2018, IDENTIFIER NCT037029
[7]   Therapeutic Plasma Exchange in Critically Ill Children Requiring Intensive Care [J].
Cortina, Gerard ;
McRae, Rosemary ;
Chiletti, Roberto ;
Butt, Warwick .
PEDIATRIC CRITICAL CARE MEDICINE, 2018, 19 (02) :E97-E104
[8]   Serum neopterin and soluble CD163 as markers of macrophage activation in paracetamol (acetaminophen)-induced human acute liver injury [J].
Craig, D. G. ;
Lee, P. ;
Pryde, E. A. ;
Hayes, P. C. ;
Simpson, K. J. .
ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 2013, 38 (11-12) :1395-1404
[9]  
Demirkol D., 2010, CRIT CARE, V14
[10]   Acute liver failure in children and adolescents [J].
Dhawan, Anil .
CLINICS AND RESEARCH IN HEPATOLOGY AND GASTROENTEROLOGY, 2012, 36 (03) :278-283