The Turkish Journal of Pediatrics 2021 , Vol 63 , Num 2
The role of plasma exchange in acute liver failure of autoimmune etiology
Selim Gökçe 1 ,Banu Bal Çermik 2 ,Nurettin Onur Kutlu 3 ,İlhan Ocak 4
1 Department of Pediatric Gastroenterology, Hepatology and Nutrition, İstanbul Yeni Yüzyıl University, Gaziosmanpaşa Hospital, İstanbul, Turkey
2 Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmialem Vakıf University, İstanbul, Turkey
3 Departments of Pediatric Intensive Care, Bezmialem Vakıf University, İstanbul, Turkey
4 Intensive Care Unit, İstanbul Memorial Hospital, İstanbul, Turkey
DOI : 10.24953/turkjped.2021.02.019 Background. Autoimmune hepatitis (AIH) is characterized by increased immunoglobulin G (IgG) levels, the presence of autoantibodies, and various degrees of lymphocyte predominant inflammation and fibrosis histologically. Immunosuppressive therapy induces remission in approximately 80% of those affected. However, liver transplantation is indicated in patients with acute liver failure with encephalopathy at presentation. Liver supporting systems, including plasma exchange (PE) allow bridging patients to transplantation or spontaneous recovery in the setting of liver failure. The role of these systems has not been assessed in children with liver failure of autoimmune etiology.

Case. Herein, we report three cases of AIH with fulminant presentation, with marked symptom resolution with PE as an adjunct therapeutic option to immunosuppressive treatment.

Conclusion. In the setting of AIH, PE may have a special therapeutic role by removing autoantibodies and cytokines, therefore preventing further liver damage and decompensation, and allowing time for recovery Keywords : children, plasma exchange, treatment, autoimmune hepatitis

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