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. 2013;8(3):e58738.
doi: 10.1371/journal.pone.0058738. Epub 2013 Mar 14.

Artificial liver support system combined with liver transplantation in the treatment of patients with acute-on-chronic liver failure

Xiao Xu  1 , Xiaoli Liu, Qi Ling, Qiang Wei, Zhikun Liu, Xiaowei Xu, Lin Zhou, Min Zhang, Jian Wu, Jianrong Huang, Jifang Sheng, Shusen Zheng, Lanjuan Li
Affiliations

Artificial liver support system combined with liver transplantation in the treatment of patients with acute-on-chronic liver failure

Xiao Xu et al. PLoS One. 2013.

Retraction in

Abstract

Background: The search for a strategy to provide temporary liver support and salvage the patients with acute-on-chronic liver failure (ACLF) remains an important issue. This study was designed to evaluate the experience in artificial liver support system (ALSS) combined with liver transplantation (LT) in the treatment of ACLF.

Methodology/principal findings: One hundred and seventy one patients with HBV related ACLF undergoing LT between January 2001 and December 2009 were included. Of the 171 patients, 115 received 247 sessions of plasma exchange-centered ALSS treatment prior to LT (ALSS-LT group) and the other 56 received emergency LT (LT group). The MELD score were 31±6 and 30±7 in ALSS-LT group and LT group. ALSS treatment resulted in improvement of liver function and better tolerance to LT. The average level of serum total bilirubin before LT was lower than that before the first time of ALSS treatment. The median waiting time for a donor liver was 12 days (2-226 days) from the first run of ALSS treatment to LT. Compared to LT group, the beneficial influences of ALSS on intraoperative blood loss and endotracheal intubation time were also observed in ALSS-LT group. The 1-year and 5-year survival rates in the ALSS-LT group and LT group were 79.2% and 83%, 69.7% and 78.6%.

Conclusions/significance: Plasma exchange-centered ALSS is beneficial in salvaging patients with ACLF when a donor liver is not available. The consequential LT is the fundamental treatment modality to rescue these patients and lead to a similar survival rate as those patients receiving emergency transplantation.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Comparison of patient cumulative survival between ALSS-LT group and LT group.
(P = 0.406) (ALSS, artificial liver support system; LT, liver transplantation).
See this image and copyright information in PMC

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Grants and funding

Financial support to the project: this work was supported by the National Science and Technology Major Project (2012ZX10002004), the National High Technology Research and Development Program of China (863 Program 2012AA020204) and the National Basic Research Program of China (973 program 2009CB522404). The funders had no role in study design, data collection and analysis, decision to publish, and preparation of the manuscript.