The efficacy and safety of regional citrate anticoagulation centrifugal plasma exchange is equivalent to those of systemic heparin anticoagulation membrane plasma exchange in patients with liver failure: a single center retrospective cohort study

Abstract Background: The purpose of this study is to compare with the efficacy and safety of regional citrate anticoagulation centrifugal plasma exchange and systemic heparin anticoagulation membrane plasma exchange in patients with liver failure.Methods: This study was a single center and retrospective study. All enrolled liver failure patients were treated with therapeutic plasma exchange. The patients treated by regional citrate anticoagulation centrifugal plasma exchange were defined as RCA group and those treated by systemic heparin anticoagulation membrane plasma exchange were defined as heparin group, respectively. Survival and clinical characteristics, including patients’ age, gender, total bilirubin, serum creatinine, international normalized ratio, platelet count, types of liver failure, arterial blood gas analysis, the model for end-stage liver disease (MELD) score, and occurrence of complications were compared between the two groups. Survival analyses of two groups and subgroups classified by MELD score were performed by Kaplan-Meier method and were compared by the log-rank test.Results: There were 69 patients enrolled in this study, 51 patients in RCA group and 18 patients in heparin group respectively. In overall patients, the 28-day mortality rate was 41% in RCA group and 39% in heparin group (P > 0.05). The 90-day mortality rate was 59% in RCA group and 50% in heparin group (P > 0.05). MELD best-fit value is 30, and area under the ROC curve is 0.7208 in the transplantation free patients with liver failure in both RCA group and heparin group. There was no significant difference in the occurrence of complications between the two groups.Conclusions: In conclusion, our study demonstrates that the efficacy and safety of regional citrate anticoagulation centrifugal plasma exchange is equivalent to those of systemic heparin anticoagulation membrane plasma exchange in patients with liver failure. RCA plasma exchange at an interval of 48 hours in patients with acute or acute-on-chronic liver failure may be an effective in reducing the occurrence of the complication of citrate accumulation. RCA centrifugal plasma exchange treatment can achieve a good prognosis and well tolerance, especially in MELD<30 patients with liver failure.