Therapeutic Plasma Exchange Versus Standard Medical Treatment in Acute Liver Failure: A Real-World Study

Background: 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 are limited. Methods : This real-world study 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.