Evidence map›Paper›PMID 40314913›Full record

ArticleHepatology international2025

Plasma exchange improves survival with native liver in Wilson disease with new Wilson's index ≥ 11 & early hepatic encephalopathy.

Snigdha Verma, Seema Alam, Bikrant Bihari Lal, Tamoghna Biswas, Vikrant Sood, Rajeev Khanna, Meenu Bajpai

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Article in Hepatology international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Snigdha VermaDepartment of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India.
Seema AlamDepartment of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India. seema_alam@hotmail.com.ORCID http://orcid.org/0000-0003-0888-8625
Bikrant Bihari LalDepartment of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India.
Tamoghna BiswasDepartment of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India.
Vikrant SoodDepartment of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India.
Rajeev KhannaDepartment of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India.
Meenu BajpaiDepartment of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimDecision about liver transplant is difficult in Wilson disease (WD) with liver failure, especially with conflicting reports about new Wilson index (NWI). Therapeutic plasma exchange (TPE) can provide survival with native liver (SNL) in WD. This study was done to see the effect of TPE on outcome and identify factors for SNL.

methodsAll cases of WD with liver failure (INR. ≥ 2.5) from prospectively maintained data were included for propensity score matching (PSM) to select TPE (n = 48) and no-TPE (n = 48) groups. Three sessions of TPE on three consecutive days were given to TPE group.

resultsOne hundred fifty-nine cases were included in the PSM with NWI & hepatic encephalopathy (HE) grading as predictors. SNL was comparable (26 vs. 17 cases (OR 1.45, p = 0.05) when the analysis was done in the whole cohort of 96 patients. SNL significantly improved when performed in those with no to early HE: TPE group (24/37) versus no-TPE group (14/34) (OR = 1.70, p = 0.03). Kaplan-Meier survival curves were significantly (log rank 0.019) improved in the TPE group when analyzing in no to early HE. Lower INR (adjusted OR 0.47, 95%CI 0.28-0.79, p = 0.005) and TPE administration (adjusted OR 3.12, 95%CI 1.10-9.4, p = 0.032) at enrollment were independently associated with SNL. Lower NWI (adjusted OR 0.686, 95%CI 0.53-0.89, p = 0.005) at 96 h was independently associated with SNL.

conclusionsTPE is independently associated with improvement in SNL by threefold in patients with NWI ≥ 11 and no to early HE. Patients with advanced HE should be offered immediate liver transplant. After 3 sessions of TPE, NWI < 11 increases SNL by 32%. Hence, NWI should be maintained below 11 with more sessions of TPE.

Indexed as

Hepatic EncephalopathyHepatolenticular DegenerationLiver FailurePlasma ExchangeAdolescentAdultChildFemaleHumansKaplan-Meier EstimateLiverLiver TransplantationMalePropensity ScoreProspective StudiesRetrospective StudiesNew Wilson indexSurvival with native liverTherapeutic plasma exchangeWilson disease

Identifiers

PMID40314913

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.