BACKGROUND: Although total plasma exchange (TPE) has been used in ABO incompatibility, and in cases of allograft dysfunction particularly in the presence of a positive cross match, the role of TPE after deceased-donor liver transplantation (DDLT) remains poorly defined. The AIM of this study was to retrospectively evaluate the impact of TPE on allograft survival following DDLT at our center.

MATERIALS: During 1998 to 2007, there were 1679 DDLT performed at our center. TPE was clinically determined and performed with 3 to 7 exchanges with FFP as replacement and with IVIG (2 mg/kg) administered at the completion of the last exchange. Graft survival was determined using SPSS 17.0.

RESULTS: Among 1679 DDLT, 48 had TPE (TPE+) in the posttransplant periods. The TPE- and TPE+ groups had equivalent recipient ages (54.2±10.5 vs 54.3±11.5, p=0.937), donor ages (46.4±19.8 vs 44.8±18.8,p=0.570), diagnosis of hepatitis C (39.6% vs 35.4%, p=0.559), donor risk indices (1.69±0.5 vs 1.68±0.4, p=0.926), cold ischemic times in h (7.0±2.0 vs 6.9±1.8, p=0.647); but significantly different MELD (18.0±8.5 vs 24.2±9.3, p<0.001), respectively. The graft survivals at 1, 3, 5, and 10 years after DDLT were 82.3%, 74.5%, 68.4%, and 55.5% respectively for TPE- recipients as compared to those 60.4%, 47.9%, 41.7%, and 28.6% respectively for TPE+ recipients (Log Rank p<0.001). The result of cross-match that was positive in 28 and negative in 20 patients showed no statistical difference on the graft survival. Figure 1 show the graft outcomes in overall 48 TPE+ recipients and Figure 2 show the graft outcomes in the 28 TPE+ recipients of the primary DDLT.

CONCLUSION: TPE does not alter the allograft outcome in DDLT when TPE is clinically determined to be performed for allograft dysfunction and positive cross-match. While the study is limited by the small sample size and retrospective nature, it does suggest that the decision to relist a DDLT recipient who demonstrates significant allograft dysfunction should be made without initiation of TPE since it does not provide additional benefit. Future investigations on the role of TPE following DDLT are warranted.

« Back to 2013 American Transplant Congress