Association between volume of processed plasma and total bilirubin reduction during plasma adsorption for severe liver disease.

Background: The double plasma molecular adsorption system (DPMAS) is a crucial therapeutic modality for the management of severe liver disease. Current literature reports considerable variability in the volume of processed plasma (VPP) utilized during DPMAS treatment, and there is currently no consensus on the appropriate VPP. We aimed to investigate the relationship between VPP and changes in total bilirubin levels during DPMAS treatment.

Methods: A prospective observational study with a repeated-measures design was conducted in patients with severe liver disease. The generalized estimation equations were used to evaluate the relationship between VPP and changes in total bilirubin levels during DPMAS treatment. The Bonferroni method was used for multiple comparisons. Tests for linear trends were performed by entering the median value of each category as a continuous variable. Total bilirubin level were detected repeatedly at four different times (four different VPP) (at 0.0 h (0 mL); at 2.0 h (3000 mL); at 2.5 h (3750 mL); at 3.0 h (4500 mL)).

Results: Twenty-nine patients who underwent 75 sessions of DPMAS treatment were enrolled. The baseline total bilirubin levels and model for end-stage liver disease score were 426.1 (356.6-487.3) μmol/L and 21.9 (18.7-24.9). The total bilirubin levels and their reduction ratios in all patients (75 sessions) or patients with total bilirubin <425 μmol/L (39 sessions) or ≥425 μmol/L (36 sessions) decreased gradually and significantly at four different times (four different VPP) (all adjusted P for pairwise comparisons <0.001; adjusted P for trend <0.001). The reduction ratios of total bilirubin in patients with total bilirubin ≥425 μmol/L were similar to those with total bilirubin <425 μmol/L (adjusted OR (95% CI), 1.001 (0.966-1.036)). The positive relationship between the reduction ratios of total bilirubin and VPP was less remarkable in patients with higher height (adjusted P for interaction = 0.027) or lower albumin levels (adjusted P for interaction = 0.017).

Conclusion: The VPP of DPMAS treatment could be more than 4500 mL. Patients with higher height or lower albumin levels might require a higher VPP to achieve sufficient therapeutic efficacy.