Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy-a systematic review and meta-analysis

Sujata Siwatch; Arka De; Bandhanjot Kaur; Divjot Singh Lamba; Simarpreet Kaur; Virendra Singh; Aravind Gandhi Periyasamy

doi:10.3389/fmed.2024.1433324

Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy-a systematic review and meta-analysis

Front Med (Lausanne). 2024 Oct 18:11:1433324. doi: 10.3389/fmed.2024.1433324. eCollection 2024.

Authors

Sujata Siwatch¹, Arka De², Bandhanjot Kaur¹, Divjot Singh Lamba³, Simarpreet Kaur⁴, Virendra Singh², Aravind Gandhi Periyasamy⁵

Affiliations

¹ Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India.
² Department of Hepatology, PGIMER, Chandigarh, India.
³ Department of Transfusion Medicine, PGIMER, Chandigarh, India.
⁴ Department of Medicine, Microbiology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.
⁵ Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India.

Abstract

Introduction: Acute fatty liver of pregnancy (AFLP) is a fatal disease occurring in 3rd trimester. The safety and efficacy of plasmapheresis/plasma exchange (PP/PE) as an adjunctive treatment in patients of AFLP has been studied. We performed systematic review and meta-analysis to estimate the clinical parameters that included mortality rates and improvement of the biochemical parameters including Liver and Renal function enzymes, coagulopathy factors of AFLP patients.

Methods: We searched PubMed, Ovid MEDLINE, Cochrane, CINAHL and Scopus, ClinicalTrials.gov. RevMan statistical software was used for meta-analysis.

Results: Pooled survival proportion for AFLP patients treated with PP/PE was 87.74% (95% CI: 82.84 to 91.65). Efficacy of PP/PE was studied by its effect on mortality. PE/PP was associated with the reduction in the mortality with pooled odds ratio of 0.51 (95% CI: 0.08 to 3.09) with I² = 86%. Sensitivity analysis after excluding outlier study, yielded a pooled odds ratio of 0.19 (95% CI: 0.02 to 1.52) with reduced heterogeneity (I² = 63%). Biochemical parameter analysis demonstrated significant improvement post-PP/PE treatment, including decreased bilirubin (MD: 8.30, 95% CI: 6.75 to 9.84), AST (MD: 107.25, 95% CI: 52.45 to 162.06), ALT (MD: 111.08, 95% CI: 27.18 to 194.97), creatinine (MD: 1.66, 95% CI: 1.39 to 1.93), and Prothrombin time (MD: 5.08, 95% CI: 2.93 to 7.22).

Discussion: Despite some heterogeneity, PP/PE shows promise in improving biochemical parameters in AFLP patients. PE can serve as a therapeutic approach for AFLP particularly in severe or refractory cases. PE provides the time for organ to recover and helps in creating a homeostatic environment for liver. Large RCTs and propensity matched studies are needed to better understand the safety and efficacy of the treatment.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315698.

Keywords: acute fatty liver of pregnancy; biochemical improvement; efficacy; meta-analysis; mortality; plasma exchange; plasmapheresis; safety.

Publication types

Systematic Review

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. We would like to acknowledge the Indian Council of Medical Education and Research, New Delhi, for providing the funds for the project and publication charges (Project ID:9733).