Outcome of Plasma Exchange in Acute Liver Failure due to Yellow Phosphorus Poisoning: A Single-center Experience

Background:Yellow phosphorus (VP) is a protoplasmic poison that causes acute liver failure (ALF) for which liver transplantation is the definitive modality. Hereby, we present our clinical data on the role of plasma exchange (PE) in ALF due to YP poisoning when liver transplantation is not readily available. Methods: Our study is a prospective observational type, conducted between January 2017 and January 2020, which included patients with ALF due to YP poisoning requiring PE. Clinical features, quantity of poison consumed, and laboratory data before and after PE were noted, and the outcome was documented. Results:This study had 10 patients.The mean age was 30 years.The ratio of male to female being 1.5:1. The amount ofYP consumed (median) was 10 gm. Six patients consumed <= 10 gm and four consumed >10 gm. The mean of total PE sessions was 3.3. Seven patients (70%) had recovery from ALF, out of which five had consumed <10 gm of VP. Among patients who recovered after consuming VP, the mean day to get admitted to the hospital was 3.6 +/- 1.81 (p = 0.017) and the time to start PE was 4.86 +/- 1.67 days (p = 0.033). Three patients did not recover from ALF, of whom two expired. Peak total bilirubin (mg/dL) decreased to 2.76 from 9.29 (p = 0.005), serum glutamic oxaloacetic transaminase to 53.5 from 530 (IU/L) (p = 0.005), serum glutamic pyruvic transaminase to 54.5 from 378 (IU/L) (p = 0.005), international normalized ratio to 1.08 from 2.26 (p = 0.008), prothrombin time(s) decreased to 13.3 from 25.5 (p = 0.013), and activated partial thromboplastin time(s) to 24.6 from 40.8 (p = 0.007) post-PE sessions. Conclusions: Our study revealed that the patient outcome depends on the quantity of poison consumed, duration of hospitalization, and time to start PE from the day of YP consumption. PE may be considered as a bridge to liver transplant in ALF patients.