Efficacy and safety analysis of double plasma molecular adsorption system sequential plasma exchange and hemodiafiltration in the treatment of patients with liver failure complicated with renal insufficiency

Abstract

Abstract: Objective To investigate the efficacy and safety of double plasma molecular adsorption system (DPMAS) sequential plasma exchange (PE) and hemodiafiltration (HDF) in patients with liver failure complicated with renal insufficiency. Methods A retrospective analysis was conducted on 27 patients with liver failure and renal insufficiency admitted to Beijing YouAn Hospital affiliated to Capital Medical University from September 2022 to June 2023. A total of 34 patients were treated with DPMAS sequential PE and HDF. The changes in liver function, renal function, coagulation function and model for end-stage liver disease (MELD) score before and after treatment were statistically analyzed to study the short-term efficacy and safety of the combination of DPMAS sequential PE and HDF. Results The hemodynamics remained stable during the 34 treatments, all of which were successfully completed. After 12 weeks, 23 patients survived (including 5 who underwent liver transplantation), while 4 died, resulting in a non-liver transplant survival rate of 66.7% (18/27). Immediately after treatment, the indexes such as TBil(286.60±127.39)μmol/L、DBil(194.32±80.75)μmol/L,BUN(10.51±8.26)mmol/L、CREA(143.29±111.74)μmol/L、eGFR(75.98±45.21)mL/min and MELD scores(26.66±8.83) significantly decreased (P<0.05) compared to pre-treatment levels:TBil(472.60±191.34)μmol/L、DBil(317.80±125.49)μmol/L,BUN(13.56±10.39)mmol/L、CREA(172.65±131.07)μmol/L、eGFR(66.43±43.80)mL/min and MELD scores(31.6±8.9). TBil and DBil levels 24 and 72 hours post-treatment and BUN 24 hours post-treatment also significantly decreased (P<0.05). There was no significant difference in BUN, CREA, eGFR, and MELD scores at 24 and 72 hours post-treatment compared to pre-treatment (P>0.05). There was no significant change in total protein, albumin, globulin, immediately after treatment and prothrombin activity, international normalized ratio immediately after, 24 hours, and 72 hours post-treatment compared to pre-treatment (P>0.05). Conclusion The combination of DPMAS sequential PE and HDF therapy is safe for patients with liver failure complicated with renal insufficiency. This combination of artificial liver can also effectively reduce serum bilirubin levels, improve organ function and prognosis indicators in the short term. It can be used as a transitional measure before liver transplantation for patients with liver failure and renal insufficiency.

Key words: Artificial liver support system, Liver failure, Double plasma molecular adsorption, Plasma exchange, hemodiafiltration

WANG Yue-ning,ZHOU Li,ZOU Huai-bin, CHEN Yu. Efficacy and safety analysis of double plasma molecular adsorption system sequential plasma exchange and hemodiafiltration in the treatment of patients with liver failure complicated with renal insufficiency[J]. Chinese Hepatolgy, 2025, 30(10): 1398-1401.

References

[1] 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J].临床肝胆病杂志, 2019, 35(1): 38-44.
[2] Br V K, Sarin S K. Acute-on-chronic liver failure: terminology, mechanisms and management[J]. Clin Mol Hepatol, 2023, 29(3): 670689.
[3] 康玮玮, 段丽萍, 徐曼曼, 等. 慢加急性肝衰竭与失代偿性肝硬化患者合并急性肾损伤的临床特点比较[J]. 中华肝脏病杂志, 2020, 28(5):391-396.
[4] 中华医学会肝病学分会重型肝病与人工肝学组. 人工肝血液净化技术临床应用专家共识(2022 年版) [J].临床肝胆病杂志, 2022,38(4): 767-775.
[5] 周莉,陈煜.人工肝治疗肝衰竭模式选择及其疗效判断标准[J].中华肝脏病杂志,2022,30(2):127-130.
[6] Rosa-Diez G J, Joannes-Boyau O. The use of adsorption in extracorporeal liver support: the double plasma molecular adsorption system (DPMAS) [J]. Contrib Nephrol,2023, 200(42):210-217.
[7] Xu W, Zhu S, Yang L, et al. Safety and efficacy of double plasma molecular adsorption system with sequential low volume plasma exchange in intermediate-stage hepatitis B virus-related acute-on-chronic liver failure [J]. J Med Virol,2023, 95(3):e28650.
[8] 吴蓓, 杜凌遥, 马元吉, 等. 不同组合人工肝支持系统治疗乙型肝炎病毒相关早、中期慢加急性肝衰竭患者的疗效及对炎症指标的影响[J]. 中国肝脏病杂志(电子版), 2021, 13(1): 32-38.
[9] 李爽, 陈煜. 血浆紧缺情况下非生物型人工肝治疗新模式的探讨[J]. 临床肝胆病杂志, 2017, 33(9): 1687-1692.
[10] 郭伟,卢姗,范红,等.肝衰竭修复替代治疗的现状与发展对策[J].中国组织工程研究,2020,24(20):3248-3255.
[11] 周莉, 杨颜榕, 陈煜. 非生物型人工肝技术的优化与生物型人工肝研究进展[J]. 临床肝胆病杂志, 2024, 40(2): 239-245
[12] Zhang J, Luo H, Han Y, et al. Sequential versus mono double plasma molecular adsorption system in acute- on chronic liver failures: a propensity-score matched study [J].Int J Artif Organs.2022, 45(1):5-13.
[13] Fujiwara K, Abe R, Yasui S, et al. High recovery rate of consciousness by high-volume filtrate hemodiafiltration for fulminant hepatitis[J]. Hepatol Res, 2019, 49(2): 224-231.
[14] Saliba F, Bañares R, Larsen F S, et al. Artificial liver support in patients with liver failure: a modified DELPHI consensus of international experts[J]Intensive Care Med, 2022, 48(10): 1352-1367.
[15] Yang Z Y, Zhang Z W, Cheng Q Y, et al. Plasma perfusion combined with plasma exchange in chronic hepatitis B-related acute-on chronic liver failure patients[J]. Hepatol Int, 2020, 14(4): 491-502.