Therapeutic Plasma Exchange (TPE) as an Adjuvant to Supportive Management in End Stage Liver Disease Patients With High Meld (score >25) Awaiting Liver Transplantation

Background and Aim: Patients with high MELD score (>25) who are listed for liver transplantation, seek admission for jaundice, encephalopathy, coagulopathy, or multisystem organ dysfunction and mortality rates are high without liver transplantation. Hence our aim of the study was to determine the role of therapeutic plasma exchange (TPE) in ESLD patients with high MELD (≥25) awaiting liver transplant. Methods: Patients with ESLD listed for LT with MELD score of 25 and more were offered either TPE with supportive treatment (cases) or supportive treatment alone (controls). TPE was repeated when there was worsening of biochemical parameters. Response to TPE with supportive treatment was assessed by change in MELD score, liver function tests, platelet count and improvement in organ dysfunction. These same parameters were compared with control group. The primary end point was biochemical response and the secondary end point was liver transplant and overall survival without transplant. Results: Both cases (39 patients) and controls (22 patients) were comparable for demography and clinical parameters. The median decline in MELD (P value 0.004), total bilirubin (P value <0.001) and INR (P value 0.002) was statistically significant in cases and not so for other parameters. The risk of mortality was 1.96 times higher in controls, when compared to TPE (95% CI 1.03–3.79, P value 0.039). The cumulative survival was higher in TPE group, compared to the controls. This difference in the survival function was statistically significant (P value 0.031). Four out of 39 patients on TPE and only one on supportive care underwent successful liver transplant. Conclusion: TPE in ESLD patients temporarily improves MELD score by reduction in serum bilirubin and INR. Hence, it is an alternative support system to stabilize the patients while waiting for liver transplant. The authors have none to declare.