{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:16:24Z","timestamp":1792444584788,"version":"4.5.0"},"reference-count":16,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ther Apher Dial"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute liver failure (ALF) and acute\u2010on\u2010chronic liver failure (ACLF) carry substantial short\u2010term mortality. While liver transplantation is the definitive therapy, access is often delayed in settings reliant on living\u2010donor transplantation, such as Egypt. Therapeutic plasma exchange (TPE) has emerged as a potential bridging strategy, but evidence from resource\u2010limited health systems remains scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a prospective randomized pilot study including 46 adults with ALF or ACLF at a tertiary center in Egypt. Participants were assigned to standard medical therapy (SMT;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915), standard\u2010volume plasma exchange (SVPE;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916), or high\u2010volume plasma exchange (HVPE;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915). SVPE involved exchange of 1.5\u20132.0 plasma volumes per session, whereas HVPE delivered 8\u201312\u2009L\/day for 3 consecutive days. All patients received guideline\u2010based SMT. Changes in alanine aminotransferase (ALT), total bilirubin, international normalized ratio (INR), and MELD\u2010Na score were evaluated alongside procedure\u2010related complications and 90\u2010day mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both TPE strategies produced greater improvements in ALT, total bilirubin, INR, and MELD\u2010Na compared with SMT alone. HVPE achieved the largest reduction in MELD\u2010Na but was associated with higher rates of catheter\u2010related infection and neurological complications. SVPE demonstrated a more favorable safety\u2013effectiveness profile. Ninety\u2010day mortality was highest with SMT and lower in both TPE groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a resource\u2010limited tertiary setting, protocolized TPE is feasible and may improve short\u2010term outcomes in ALF and ACLF. SVPE may represent a safer and more scalable bridging strategy when immediate access to liver transplantation is limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1744-9987.70199","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T22:01:31Z","timestamp":1785103291000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Therapeutic Plasma Exchange for Acute and Acute\u2010on\u2010Chronic Liver Failure: A Randomized Pilot Study Comparing Standard\u2010 and High\u2010Volume Protocols in a Resource\u2010Limited Setting"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5914-869X","authenticated-orcid":false,"given":"Amany","family":"Sholkamy","sequence":"first","affiliation":[{"name":"Hepatogastroenterology, Liver ICU, Internal Medicine Department, Kasr Alainy School of Medicine Cairo University  Giza Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6041-4016","authenticated-orcid":false,"given":"Ahmed","family":"Fayed","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine Cairo University  Giza Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanaa A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine Cairo University  Giza Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr Osama","family":"Elsayed","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology, Liver ICU, Internal Medicine Department, Kasr Alainy School of Medicine Cairo University  Giza Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3650-5428","authenticated-orcid":false,"given":"Ahmad Mohamed","family":"Shenawy","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology, Liver ICU, Internal Medicine Department, Kasr Alainy School of Medicine Cairo University  Giza Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0960-2644","authenticated-orcid":false,"given":"Karim M.","family":"Soliman","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Thomas E. Starzl Institute of Transplantation University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4902-742X","authenticated-orcid":false,"given":"Rasha Ahmed","family":"Darwish","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine Cairo University  Giza Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/LVT.0000000000000231"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.12.003"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.04.021"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13162059"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2024.102410"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1433324"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.22010"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000547521"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.70018"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.08.018"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.21873"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v26.i2.219"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2024.101934"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072\u2010024\u201010773\u20104"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/3139929"}],"container-title":["Therapeutic Apheresis and Dialysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1744-9987.70199","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/1744-9987.70199","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1744-9987.70199","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T22:01:32Z","timestamp":1785103292000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/1744-9987.70199"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,26]]},"references-count":16,"alternative-id":["10.1002\/1744-9987.70199"],"URL":"https:\/\/doi.org\/10.1002\/1744-9987.70199","archive":["Portico"],"relation":{},"ISSN":["1744-9979","1744-9987"],"issn-type":[{"value":"1744-9979","type":"print"},{"value":"1744-9987","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,26]]},"assertion":[{"value":"2026-03-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"1744-9987.70199"}}