{
  "abstract": "Objective Severe alcohol-associated hepatitis (AAH) driven acute-on-chronic liver failure (ACLF) carries high short-term mortality, where corticosteroids offer limited benefit. This study evaluated the safety and impact of therapeutic plasma exchange (PLEX) in this setting.Design/method This prospective multicentre study included adults with severe AAH precipitating Asian Pacific Association for the Study of the Liver (APASL)-defined ACLF who received PLEX across 12 tertiary hospitals in Tamil Nadu, India. The primary outcome was 1-month transplant-free survival. Secondary outcomes included changes in disease severity scores after PLEX, survival predictors and adverse events.Results Over 3 months (June–August 2024), 51 patients (98% male, mean age 44 years) underwent PLEX; none received corticosteroids beforehand. 1-month transplant-free survival was 78.4%. Most patients (88.2%) received early PLEX (≤5 days from hospital admission); 74.5% received low-volume PLEX. Low-dose corticosteroids were used with PLEX in 82.4%. Post-PLEX, disease severity scores declined significantly (mean Model for End-Stage Liver Disease (MELD): 31.6 to 26.5; APASL ACLF Research Consortium (AARC): 10.2 to 8.4; both p<0.001), with greater reduction among survivors. Median decline in MELD score was 4 (–4 to 18) in survivors vs 1 (–3 to 10) in non-survivors (p=0.005). AARC grade III decreased from 47.1% to 13.7% post-PLEX, with greater decline in survivors than non-survivors (p=0.001). Post-PLEX AARC score predicted 1-month mortality (Area under the receiver operating characteristic curve (AUC) 0.808; p=0.002). No major adverse events occurred.Conclusions PLEX with low-dose steroids was safe and feasible in AAH-related ACLF. Post-PLEX AARC score predicted 1-month mortality. Greater declines in disease severity scores among survivors suggest their role as early response markers. These findings support further prospective evaluation of PLEX in AAH-related ACLF.",
  "authors": [
    {
      "affiliations": [
        "Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India"
      ],
      "name": "Palaniappan Alagammai"
    },
    {
      "affiliations": [
        "Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India"
      ],
      "name": "Jeyaraj Ubal Dhus"
    },
    {
      "affiliations": [
        "Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India"
      ],
      "name": "Amarnath Domakuntla"
    },
    {
      "affiliations": [
        "Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India"
      ],
      "name": "Piramanayagam Paramasivan"
    },
    {
      "affiliations": [
        "Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India"
      ],
      "name": "Natarajan Murugan"
    },
    {
      "affiliations": [
        "Gastroenterology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India"
      ],
      "name": "Adamali Shafique"
    },
    {
      "affiliations": [
        "Gastroenterology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India"
      ],
      "name": "Kandasamy Aliaskumar"
    },
    {
      "affiliations": [
        "Gastroenterology, Madurai Medical College, Madurai, Tamil Nadu, India"
      ],
      "name": "Ramani Rathnavel"
    },
    {
      "affiliations": [
        "Gastroenterology, Madurai Medical College, Madurai, Tamil Nadu, India"
      ],
      "name": "Kannan Mariappan"
    },
    {
      "affiliations": [
        "Gastroenterology, SRM Medical College Hospital and Research Centre, Kanchipuram, Tamil Nadu, India"
      ],
      "name": "Nanda Amarnath Rajesh"
    },
    {
      "affiliations": [
        "Gastroenterology, SRM Medical College Hospital and Research Centre, Kanchipuram, Tamil Nadu, India"
      ],
      "name": "Rajendiran Ramalingam"
    },
    {
      "affiliations": [
        "Hepatology, Gleneagles Global Health City, Chennai, Tamil Nadu, India"
      ],
      "name": "Jayanthi Venkataraman"
    },
    {
      "affiliations": [
        "Hepatology, Gleneagles Global Health City, Chennai, Tamil Nadu, India"
      ],
      "name": "Dinu Abirami Premkumar"
    },
    {
      "affiliations": [
        "Hepatology, Gleneagles Global Health City, Chennai, Tamil Nadu, India"
      ],
      "name": "Joy Varghese"
    },
    {
      "affiliations": [
        "Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India"
      ],
      "name": "Venkatakrishnan Leelakrishnan"
    },
    {
      "affiliations": [
        "Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India"
      ],
      "name": "Mukundan Swaminathan"
    },
    {
      "affiliations": [
        "Liver Unit, Kovai Medical Center Research and Educational Trust, Coimbatore, Tamil Nadu, India"
      ],
      "name": "Vijaya Prakash Madesh"
    },
    {
      "affiliations": [
        "Liver Unit, Kovai Medical Center Research and Educational Trust, Coimbatore, Tamil Nadu, India"
      ],
      "name": "Arulraj Ramakrishnan"
    },
    {
      "affiliations": [
        "Gastroenterology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India"
      ],
      "name": "Ganesh Panchapakesan"
    },
    {
      "affiliations": [
        "Gastroenterology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India"
      ],
      "name": "Anbu Krithigha Dharmalingam"
    },
    {
      "affiliations": [
        "Gastroenterology, SIMS Hospital Vadapalani, Chennai, Tamil Nadu, India"
      ],
      "name": "Babu Vinish"
    },
    {
      "affiliations": [
        "Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India"
      ],
      "name": "Jeyasingh Lalitha Joeimon"
    },
    {
      "affiliations": [
        "Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India"
      ],
      "name": "Madhan Madhusuriya"
    },
    {
      "affiliations": [
        "Hepatology, Christian Medical College, Vellore, Tamil Nadu, India"
      ],
      "name": "Asisha M Janeela"
    },
    {
      "affiliations": [
        "Hepatology, Christian Medical College, Vellore, Tamil Nadu, India"
      ],
      "name": "Ashish Goel"
    },
    {
      "affiliations": [
        "Hepatology, Christian Medical College, Vellore, Tamil Nadu, India"
      ],
      "name": "Chundamannil Eapen Eapen"
    }
  ],
  "title": "Therapeutic plasma exchange in severe alcohol-associated hepatitis-related acute-on-chronic liver failure",
  "uid": "dfa6840b-e8cd-536c-89d6-94a091786b35"
}