Can therapeutic plasma exchange save lives in acute-on-chronic liver failure, or does it simply delay the inevitable?
In Season 1, Episode 61 of PRISM Rounds, we examine a 2026 randomized controlled trial published in Hepatology evaluating therapeutic plasma exchange in 194 patients with acute-on-chronic liver failure (ACLF).
The findings are striking. Plasma exchange reduced 28-day mortality from 63.9% to 44.3%, an absolute difference of nearly 20 percentage points. However, by 90 days, mortality was similar between groups, and more than 40% of patients could not complete the planned treatment.
We examine the trial's methodology, treatment complications, and clinical implications alongside the 2023 EASL guidelines and a 2025 meta-analysis of plasma exchange in ACLF.
The central question: Does plasma exchange meaningfully alter the course of liver failure, or does it provide a temporary bridge to hepatic recovery or transplantation?
Join us as we explore what this trial should, and should not, change in ICU practice.
Read the primary study:
https://doi.org/10.1097/HEP.0000000000001755
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Tags
Critical Care, Intensive Care, Hepatology, Acute-on-Chronic Liver Failure, ACLF, Therapeutic Plasma Exchange, Plasmapheresis, Liver Failure, Liver Transplantation, Randomized Controlled Trial, Evidence-Based Medicine, ICU Research, PRISM Rounds
