The impact of total plasma exchange on early allograft dysfunction

C. Camci, M. Akdogan, A. Gurakar, R. Gilcher, J. Rose, R. Monlux, S. Alamain, H. Wright, A. Sebastian, Bakr Nour

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Abstract

Early allograft dysfunction (EAD) is a rare but serious complication encountered among patients undergoing liver transplant surgery. Total plasma exchange (TPE) in EAD has been suggested, but its role is still considered investigational. We retrospectively assessed the efficacy of TPE in EAD and its impact on other parameters of liver function. Between 1995 and 2001, 25 orthotopic liver transplant recipients developed EAD, which was defined as early postoperative prothrombin time (PT) >17 seconds, aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) >2500 IU/L, and/or the presence of hepatic encephalopathy, and development of renal failure. Daily TPE was performed using the Cobe Spectra TPE (Gambro) for 4 hours until an adequate clinical response, the patient underwent retransplantation, or the patient died. International normalizing ratio (INR), partial thromboplastin time (PTT), fibrinogen, ALT, AST, gamma-glutanyl transpeptidase (GGT), blood urea nitrogen (BUN), ammonia, and total bilirubin were analyzed before and after TPE. Student t and chi-square tests were used for statistical analysis. Twenty-five patients with EAD included 13 females, 12 males of mean age 42.3 years (range, 1-63 years). Coagulopathy and hyperbilirubinemia significantly improved with TPE. Nineteen patients (76%) survived and 2 required retransplantation. Mean number of TPE sessions was 4.3. TPE was effective to correct coagulopathy and improve liver function. These results suggest the benefit of potential temporary liver support until recovery or retransplantation, in the absence of sepsis or multi-system organ failure.

Original languageEnglish
Pages (from-to)2567-2569
Number of pages3
JournalTransplantation Proceedings
Volume36
Issue number9
DOIs
Publication statusPublished - Nov 2004
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Camci, C., Akdogan, M., Gurakar, A., Gilcher, R., Rose, J., Monlux, R., Alamain, S., Wright, H., Sebastian, A., & Nour, B. (2004). The impact of total plasma exchange on early allograft dysfunction. Transplantation Proceedings, 36(9), 2567-2569. https://doi.org/10.1016/j.transproceed.2004.09.071