DOUBLE PLASMA MOLECULAR ADSORPTION IN PATIENTS WITH ACUTE-

ON CHRONIC LIVER FAILURE- AN INITIAL EXPERIENCE

Sanjay Govil, Raje Gowda, Anindita Mukherjee, Nagesh PN
Sandeep Satsangi, Anurag Agarwal, Jayanth Reddy, Suresh Raghavaiah,

Department of Hepatology, HPB surgery and Multi-organ abdominal transplantation, Apollo Hospitals, Bengaluru, India

INTRODUCTION RESULTS
Acute-on chronic liver failure (ACLF) carries a high mortality due to involvement of liver and is
characterised by having multiple extrahepatic organ failures (OFs).
CASE 1 CASE 2
The primary treatment of ACLF involves treating the acute precipitant and intensively managing the
38 year old man with Alcoholic hepatitis related ACLF-III. His OFs were Liver, kidney, coagulopathy, 42 year old female with AIH related ACLF-III with 4 OFs (Liver, kidney, coagulopathy and cerebral).
OFs.
Cerebral. He underwent two sessions of DPMAS following which his OFs improved to grade I ACLF. The The patient underwent one cycle of DPMAS after which her OFs improved and she was in ACLF-II. She
Therapies to augment recovery and bridge to a liver transplant remain pivotal and need more data.
patient however developed sepsis two weeks later and passed away with septic shock at a local hospital. underwent an urgent LDLT after which she made a complete clinical recovery.
We have used Double plasma Molecular adsorption system (DPMAS) for twelve patients with ACLF,
however the data of three patients with high grade ACLF (≥4OFs) are being presented here.

DPMAS DPMAS

PATIENTS AND METHODS done done

Three patients with ACLF – III were treated with DPMAS (Combining BSS 330 and HA 330-II
filters).
Each session lasted for a period of 8 hrs.
DPMAS is an extracorporeal procedure that combines two hemoperfusion machines.
During the procedure, toxic plasma is separated and cleansed by perfusion over two adsorbers (BS
330 and HA 330-II), and the final cleansed plasma is then returned to patients.

CONCLUSION
DPMAS combines two hemoperfusion filters and aims to stabilize the organ functions in patients with
ACLF.
DPMAS- Helps reduce the bilirubin, cytokines and hepatotoxins
Resultant improvement in AKI
–Bile cast nephropathy
–Improves terlipressin responsiveness DPMAS
Preservation of lungs done
–ARDS (Pa02/FiO2 <200)
–Poor prognostic marker for LT in ACLF
–More chances to develop Transfusion related acute lung injury with therapeutic plasma exchange
v/s DPMS
Whether reduction in inflammatory mediators would result in improvement of transplant free survival
CASE 3
– More RCTs needed 50 year old male with NASH cirrhosis with ACLF
We have used and also advocate the DPMAS primarily as a bridge to liver transplant in patients with
advanced grades of ACLF.
being triggered by COVID-19 infection. Patient had
5 OFs (Liver, kidney, coagulopathy, cerebral and

REFERENCES
circulatory). He underwent three sessions of
DPMAS with which his OFs improved to 2 OFs
(ACLF-II). He was taken up for an emergency
1. Chen, G., Wu, M., Wu, B., Liu, F., Liu, J., & Liu, L. (2019). Effects of dual plasma molecular LDLT. Patient was extubated and was doing well
adsorption system on liver function, electrolytes, inflammation, and immunity in patients with initially with improving graft functions, however he
chronic severe hepatitis. Journal of clinical laboratory analysis, 33(7), e22926.
https://doi.org/10.1002/jcla.22926 succumbed on day 32 post-op with fungal sepsis. No
2. Askari S, Nollet K, Debol SM, Brunstein CG, Eastlund T. Transfusion-related acute lung injury patients had any adverse events related to the
during plasma exchange: Suspecting the unsuspected. J Clin Apher. 2002;17(2):93-6. doi:
10.1002/jca.10013. PMID: 12210713. DPMAS procedure.