Plasmapheresis in the Treatment of Chronic Liver Diseases. Cirrhosis
Currently the treatment of choice for critical liver failure is liver transplantation. Liver failure is treated conservatively until a matching liver donor becomes available. The therapeutic plasma exchange (TPE) plays an important role as a bridge to transplantation by removing accumulated toxins from patient plasma, as well as restoring the coagulation profile.
Based on the results of our study, we conclude that the TPE improves the liver function tests, coagulation profile and short-term survival in patients with critical liver diseases, despite the continuing poor overall survival. Hence, judicious use of the TPE is recommended as supportive therapy in the performance of liver transplantation in these patients. Randomized control trials are required to further establish the definitive role and effects of the TPE in the treatment of liver failure patients.
Thus, the picture of homeostasis disorders, leading to an increase in organ disorders, is becoming increasingly clear. The presented materials indicate a variety of causes of liver damage, but
they are all combined pathogenetic mechanisms associated with
the accumulation of a number of toxic products that damage the
liver parenchyma. In this case, many pathological substances accumulate, the size of molecules which does not allow their excretion by the kidneys, while the liver is also unable to destroy them.
On the other hand, the fact of their accumulation suggests that no
drugs can help them to leave the body.
To date, significant progress has been made in the treatment of
viral infections, but these drugs themselves are not safe and are not
always able to interrupt the already existing pathological liver disorders that still require the use of plasmapheresis. Therefore, in all
these cases, plasmapheresis is a pathogenetically justified method
of treatment and prevention of progression of liver damage.
In such cases, it is sufficient to remove up to 1 liter of plasma
with the replacement of only crystalloid solutions for 4 such sessions of plasmapheresis, held every other day, which can be provided even in outpatient settings. In the future, it is necessary to
regularly repeat such courses up to two times a year. Thus, it is
possible to effectively interrupt the progression of the disease and
the transition to the development of irreversible liver damage in
cirrhosis and hepatocellular carcinoma. But even with far-reaching
processes, plasmapheresis can significantly improve the condition