These children develop life-threatening complications, including

These children develop life-threatening complications, including refractory coagulopathies, hepatic encephalopathy, multi-organ failure and death. Therapies for patients awaiting transplant are merely supportive, including large volumes of blood products to correct coagulopathy, resulting

in volume and protein overload and citrate toxicity. Therapeutic plasma exchange (TPE) allows for a bridge to either recovery or transplant by correcting coagulopathies, PCI32765 clearing toxins, and improving cytokine balance. There are no published pediatric studies describing the safety of TPE in children with hepatic failure. Methods: Charts of ESLD patients from 2010-2013 at Texas Children’s Hospital who received TPE for hepatic encephalopathy, severe coagulopathy, selleck chemicals or ABO mismatch

liver transplant (n=20) were reviewed. TPE was performed by replacing 1.5 total plasma volume with fresh frozen plasma, and anticoagulation was regional with citrate. A protocol for TPE was used for all patients in 2013 (n = 10), and included 5 daily TPE treatments, followed by every other day treatments until recovery, transplant or death. Prior to this protocol, TPE was used randomly on a physician-directed basis. Data: Over 4 years, 20 patients with ESLD were supported with TPE for a total of 102 treatments. Patients received 5 treatments on average. No infectious complications or deaths were associated with TPE. TPE was done in tandem with CRRT in the majority of patients (85%). Citrate lock, MCE defined as a total calcium to ionized calcium ratio of ≥ 2.4, was seen in the majority of patients (85%), and improved by increasing calcium chloride. 60% of patients experienced hypotension requiring increased inotropic support, and 60% experienced complications with catheters including bleeding and/or clotting (67%). Despite these side effects, no treatment interruption was necessary, even in patients on multiple vasoactive agents. In the 10 patients subject to the 2013 TPE protocol, 4 were successfully

bridged to liver transplantation, and 1 had spontaneous resolution of disease. Prior to the 2013 protocol, 4/10 patients were successfully bridged to transplant. Conclusion: These data demonstrate the safety of TPE in children with ESLD. Despite commonly experiencing severe citrate lock, hemodynamic instability, and catheter complications, TPE was well tolerated and did not result in cessation of therapy or death. The benefits of TPE as a therapeutic bridge allows for longer survival while awaiting liver transplant. Disclosures: The following people have nothing to disclose: Amy S. Arrington, Moreshwar S. Desai, Ayse Akcan Arikan, Jun Teruya, Poyyapakkam R. Srivaths Background: Acetaminophen hepatotoxicity is the leading cause of ALF and can be fatal when liver fails to regenerate. If hepatic stem/progenitor cells were recruited in ALF efforts to amplify such cells could offer novel therapies.

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