Therapeutic Plasma Exchange in Acute Liver Failure: A Real-World Study

Background/Objectives: Acute liver failure (ALF) is a life-threatening condition with high mortality in nontransplant candidates. Therapeutic plasma exchange (TPE) has emerged as a promising intervention for removing inflammatory mediators and toxic metabolites. In Latin America, data on the efficacy of TPE in ALF patients is limited. This real-world study aimed to compare 30-day survival outcomes between patients receiving standard medical treatment (SMT) and those receiving SMT plus TPE. Methods: We analyzed 25 ALF patients admitted to the tertiary intensive care unit (ICU) of Hospital Juárez of Mexico City, Mexico, from 2018–2024. Patients received either standard medical treatment (SMT group, n=12) or SMT with TPE (TPE group, n=13), including high-volume TPE (n=8) and standard-volume TPE (n=5). Survival analysis was performed via Kaplan‒Meier estimates, and binomial regression analysis was run to estimate the mortality probability stratified by the hepatic encephalopathy grade. Results: At 30 days, survival was significantly greater in the TPE group (92%) than in the SMT group (50%) (p = 0.02). The greatest survival benefit was observed in patients with Grade 4 encephalopathy. The ICU stay was longer in the TPE group, reflecting the complexity of ALF management. Conclusion: TPE significantly improves 30-day survival in ALF patients compared with SMT alone, supporting its role as an adjunct therapy. Further studies are needed to refine patient selection and optimize treatment protocols.