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Abstract
Background:
Severe graft dysfunction has been occasionally encountered following adult living donor liver transplantation (LDLT). This study intended to assess the effectiveness of plasmapheresis (PP) as a liver supportive measure in LDLT recipients showing severe graft dysfunction.
Methods:
During 1 year of 2007, 276 adult LDLTs were performed in our institution. Of them 27 underwent PP therapy as a liver support.
Results:
Seventeen underwent PP during the first month following LDLT and another 10 underwent PP after that period. The underlying causes of such liver support were acute and chronic rejections, ischemic damage, viral hepatitis recurrence and unknown causes. A total of 329 sessions of PP were performed for these 27 patients, indicating 12.2±9.9 times per patient for 28.1±32.2 days. Concurrent hemodiafiltration was done in 66.7%. Serum total bilirubin level was significantly reduced following PP therapy: 23.2±6.5 mg/dL before PP and 14.4±5.6 mg/dL at 1 week after completion of PP (P＜0.001). Other biochemical parameters did not significantly affected by PP. Overall 1-year patient survival rate was 63.0%. Six-month graft survival rate after completion of PP was 82.6% in 17 patients undergoing PP during the first posttransplant month and 30% in 10 patients undergoing PP after 1 month (P= 0.013).
Conclusions:
The results of this study implicate that PP has a beneficial effect on the recovery of liver graft function, especially during the early posttransplant period. We suggest to perform active application of PP therapy for liver recipients showing severe graft dysfunction of total bilirubin greater than 15∼20 mg/dL.
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Fig. 1.
Number of plasmapheresis sessions per one recipient undergone living donor liver transplantation.
Fig. 2.
Overall patient survival curve of 27 adult living donor liver transplant recipients undergoing plasmapheresis for liver support.
Table 1.
Comparison of the biochemical profiles in 27 adult living donor liver transplant recipients undergoing plasmapheresis (PP) for liver support
| Before start of PP | After 1 week during PP | 1 week after last PP | P-value∗ | |
|---|---|---|---|---|
| Total bilirubin (mg/dL) | 23.2±6.5 | 19.6±8.9 | 14.4±5.6 | ＜0.001 |
| Prothrombin time (INR) | 1.47±0.35 | 1.38±0.37 | 1.33±0.63 | 0.317 |
| AST (IU/L) | 120.3±341.7 | 145.6±212.3 | 108.4±98.5 | 0.747 |
| ALT (IU/L) | 148.4±287.1 | 156.0±198.8 | 98.2±86.4 | 0.389 |
| Ammonia (μ mol/L) | 75.6±40.1 | 75.8±41.3 | 73.2±37.8 | 0.822 |
| Lactate (μ mol/L) | 3.4±2.1 | 3.7±2.6 | 3.6±4.1 | 0.811 |
| Cholesterol (mg/dL) | 74.3±40.8 | 89.6±47.4 | 96.5±55.1 | 0.098 |
| Albumin (g/dL) | 2.9±0.5 | 3.3±0.3 | 3.2±0.8 | 0.105 |
| BUN (mg/dL) | 55.4±27.1 | 49.8±28.1 | 42.7±25.4 | 0.081 |
| Creatinine (mg/dL) | 1.67±1.1 | 1.52±0.9 | 1.38±0.7 | 0.253 |
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