Introduction: Liver transplantation (LT) is a life-saving, definitive and proven treatment for patients with acute and chronic end-stage liver disease.  The role of therapeutic plasma exchange (TPE) is unclear during postoperative period of LT. TPE may improve the prognosis and outcomes among patients with hyperbilirubinemia, small for size syndrome (SFSS) and delayed graft function (DGF) after LT. This study aims to report our experiences about the usage of TPE among LT recipients following early postoperative LT in critical care unit (CCU).
Material and Method: We retrospectively analyzed medical records of LT recipients who underwent TPE during early postoperative period from January 2019 to January 2024.
Results: A total of 113 patients who underwent LT, TPE was performed in 75 LT recipients. There was missing data in 2 LT recipients and 73 (46 males, 63%; 27 females, 37%) were included in the study. The mean age was 17.3±21.1 years, 52 LT recipients (72.1%) were under 18 years of age. Sixty nine of the transplanted organs (94.5%) were living donors and 4 (5.5%) were cadaveric. The most common etiology was metabolic diseases (26%). TPE was performed for SFSS in 3 LT recipients (4.1%) and for DGF in 70 LT recipients (95.9%). TPE was used in 67 LT recipients (91.8%) with the volume of 20% ideal body weight per session. A total of 314 sessions of TPE were performed for 73 LT recipients, indicating 4.3±4.9 times per patient and for 6.2±4.8 days. The mean duration of a TPE session was 1.6±0.5 hours. Concomitant continuous veno-venous hemodiafiltration was performed in 13.7%. When compared before and after TPE, TPE resulted in a statistically significant reduction in the serum levels of total/direct bilirubin, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase and lactate. A non-statistically significant decrease was observed in serum ammonia level and international normalized ratio. The mean length of CCU and hospital stay were 6.2±4.8 and 23.0±11.7 days. The CCU mortality rate was 17.8 % (n=13).
Conclusion: Our study demonstrates the beneficial effects of TPE, which appears to be an effective treatment option for delayed graft function, small for size syndrome and hyperbilirubinemia after LT. Therefore, TPE may be considered as an extracorporeal liver support system that improves liver regeneration and recovery during the early postoperative LT.