Role of Therapeutic Plasma Exchange Plasmapheresis in Liver Disease Patients and Its Effects on Clinical and Immunological Parameters

Abstract

A Plasmapheresis is the removal or exchange of plasma. In earlier days, it was defined as a manual procedure consisting of repeated cycles of blood extraction followed by ex vivo centrifugation and discarding the plasma as well as reintroducing blood cells to the patient with the acceptable replacement solution. Therapeutic plasmapheresis and Therapeutic Plasma Exchange (TPE) are terms that often are used synonymously. The plasma that s removed is often replaced by Fresh Frozen Plasma (FFP), 5% albumin or similar colloidal solution, or the patient s own plasma after a secondary online purification procedure. My study on role of (TPE) revealed that, 1. In acute liver failure particularly due to yellow phosphorus poison ingestion, it significantly improved both biochemical and clinical outcome of the patients without liver transplantation. Hence, it can be considered as a therapeutic tool in selected ALF patients. 2. In decompensated chronic liver disease with high MELD score patients while awaiting for liver transplantation, it acted as a bridge therapy to stabilize his liver function parameters and reduced waiting list mortality. Hence, it would play a major role among high MELD cirrhotic patients who are waiting for cadaver organ for liver transplantation or while evaluating potential live donor for living donor liver transplantation. 3. In acute on chronic liver failure patients, it improved patients survival by improving both biochemical parameters as well as hepatic encephalopathy. The clinical improvement of the patient was interestingly correlated well with significant reduction in vWF level after TPE. This explains role of vWF in liver diseases as well as role of TPE on vWF. 4. In various liver disorders such as acute liver failure, acute on chronic liver diseases as well as in acute cellular rejection in liver transplant recipient, it reduces pre-inflammatory cytokines and increases anti-inflammatory cytokines. This explains cytokines role in various liver diseases and therapeutic plasma exchange s effect on it.