Effects of therapeutic plasma exchange on survival in patients with postoperative liver failure: a retrospective single-center study

Background: Recent decreases in the incidence of postoperative liver failure (POLF) have been attributed to advances in surgical techniques, critical care, and postoperative management. However, POLF management remains a challenge, and worsening POLF is a significant cause of morbidity and mortality. Therapeutic plasma exchange (TPE) is used as a salvage strategy for POLF in some countries, and several studies conducted between 1980 and 1990 have reported the use of TPE for POLF. We conducted this retrospective single-center study to investigate the outcomes of patients with POLF treated with TPE. Methods: We retrospectively reviewed the charts of patients with POLF admitted to the intensive care unit who underwent TPE between November 2010 and March 2017. POLF was defined as the presence of persistent hyperbilirubinemia. Data on patient demographics, Glasgow Coma Scale score, platelet count, prothrombin time, and serum total bilirubin level were collected, and their Sequential Organ Failure Assessment scores were calculated. The lengths of postoperative hospital stays, lengths of post-TPE hospital stays, and patient outcomes were also analyzed. Results: TPE was performed in 20 patients with POLF during the study period. TPE was initiated on the 49th postoperative day and was performed for a median of five sessions. TPE improved hyperbilirubinemia and coagulopathy but had no effect on neurological and clinical symptoms. All 20 patients treated with TPE died after the 36th day (median) from the initial TPE. Conclusions: Although TPE may improve laboratory values in patients with POLF, the current study suggests that it has no survival benefit.