To explore the influencing factors of curative effect of plasma exchange in patients with HBV-related acute-on-chronic liver failure (HBV-ACLF) waiting for liver transplantation (LT).

Clinical data of 63 HBV-ACLF patients waiting for LT who received plasma exchange in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Shanghai Changzheng Hospital Affiliated to Naval Medical University from December 2016 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 54 patients were male and 9 female, aged (51±9) years on average. According to clinical prognosis, all patients were divided into the good (n=30) and poor prognosis groups (n=33). The changes of Scr, WBC, TB, blood ammonia (BA) and other indexes before and after plasma exchange were observed, and the influencing factors of curative effect of plasma exchange were analyzed. Scr_max, WBC_max and other indexes between two groups were compared by Kolmogorov-Smirnov test. The predictive value of these indexes was assessed by ROC curve.

Before plasma exchange, the Scr_max were 74(68) μmol/L and 111(74) μmol/Lin the good and poor prognosis groups, and the WBC_max were 8(5)×10⁹/L and 14(13)×10⁹/L, where significant differences were observed (Z=1.670, 2.402; P<0.05). In the good and poor prognosis groups, the differences of TB_max and BA_max before and after plasma exchange were -37%(28%) and -23%(38%), -29%(46%) and 20%(105%), where significant differences were observed (Z=1.718, 2.030; P<0.05). ROC curve analysis showed that Scr_max ≥78.5 μmol/L and WBC_max ≥12.3×10⁹/L before plasma exchange indicated poor prognosis, whereas TB decrease by 24.5% and BA increase by ≤14% of baseline level indicated good prognosis.

The key influencing factors of curative effect of plasma exchange in HBV-ACLF patients waiting for LT include preoperative renal function, inflammatory indexes and the improvement of TB and BA after plasma exchange rather than the frequency and dosage of plasma exchange.