Plasma exchange with albumin 5% (Albutein 5%, PE-A5%) added to standard medical treatment (SMT) improved outcomes in patients with acute-on-chronic liver failure (ACLF), according to the randomized phase III APACHE trial.
Among 274 patients with liver failure plus one, two, or three other organ failures, those who received PE-A5% plus SMT saw significantly lower 90-day overall mortality rates without prior liver transplant than those receiving SMT alone (37.8% vs 49.6%, HR 0.65, P=0.021).
In an exploratory subgroup analysis by ACLF grade, PE-A5% was linked with lower mortality rates mainly in less severe forms of ACLF, reported Javier Fernández, MD, PhD, of the Hospital Clínic de Barcelona in Spain, at the European Association for the Study of the Liver annual meeting in Barcelona.
"I'm not saying that plasma exchange is a substitute for liver transplantation," Fernández cautioned during his presentation. Instead, PE-A5% "is something that's going to give you time for stabilizing the patient, to improve the clinical status of the patient, to bridge the patient to liver transplantation, if the patient is a candidate."
ACLF is a severe condition in patients with chronic liver disease, in which sudden liver decompensation leads to multi-organ failure and high mortality rates. Triggers include alcohol-associated hepatitis, drug-induced liver injury, viral hepatitis, bacterial infections, and major surgical interventions. There are no FDA-approved therapies for ACLF, and the only lifesaving treatment is liver transplantation.
