{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T05:01:50Z","timestamp":1773032510439,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"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":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    High\u2010volume therapeutic plasma exchange (HV\u2010TPE) is an established treatment modality in acute liver failure; however, its role in acute\u2010on\u2010chronic liver failure (ACLF) and its comparative efficacy versus standard\u2010volume TPE (SV\u2010TPE) remain unclear. This single\u2010center, prospective, randomized pilot study conducted over 2\u2009years (2021\u20132023) compared the efficacy of HV\u2010TPE and SV\u2010TPE in patients with ACLF. Twenty\u2010two consecutive patients with ACLF Grade I and II without prospects for liver transplantation were enrolled; 11 patients underwent HV\u2010TPE, and 11 underwent SV\u2010TPE. In addition to tolerability, the effects of both TPE modalities on coagulation parameters, biochemical indices, cytokine levels (IL\u20106, IL\u201010, and TNF\u2010\u03b1), and clinical severity scores\u2014including the Asia Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) score, Maddrey discriminant function (MDF), Model for End\u2010Stage Liver Disease (MELD), and Child\u2010Turcotte\u2010Pugh (CTP) score\u2014were assessed before and after therapy. Length of hospital stay and 30\u2010day and 90\u2010day mortality were also compared. Both HV\u2010TPE and SV\u2010TPE resulted in significant improvement in coagulation parameters, including prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR), along with significant reductions in serum total and conjugated bilirubin, alkaline phosphatase, total protein, and serum ammonia (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). Significant improvement in serum urea (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004), serum creatinine (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004), and serum lactate (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.007) was observed only in the HV\u2010TPE group. Clinical severity scores (AARC, MDF, MELD, and CTP) improved significantly in both groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). There were no significant differences between the groups in 30\u2010day mortality (27% vs. 27%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20091.00), 90\u2010day mortality (36% vs. 45%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.40), or changes in cytokine levels. Procedure\u2010related adverse events were infrequent and comparable between HV\u2010TPE (6.8%) and SV\u2010TPE (5.7%). In conclusion, both HV\u2010TPE and SV\u2010TPE effectively improved clinical severity scores in patients with ACLF; however, a definitive difference in mortality benefit could not be demonstrated in this study.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration:<\/jats:bold>\n                    CTRI\/2019\/06\/019660 (dated 14 June 2019)\n                  <\/jats:p>","DOI":"10.1002\/jca.70102","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T20:44:07Z","timestamp":1773002647000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Efficacy of Standard\u2010Volume Plasma Exchange Versus High\u2010Volume Plasma Exchange in Patients With Acute\u2010on\u2010Chronic Liver Failure"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1187-1491","authenticated-orcid":false,"given":"Aarushi","family":"Sahni","sequence":"first","affiliation":[{"name":"Department of Transfusion Medicine Post Graduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7101-0853","authenticated-orcid":false,"given":"Rekha","family":"Hans","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine Post Graduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6533-9182","authenticated-orcid":false,"given":"Sharanya","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine Post Graduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7796-1764","authenticated-orcid":false,"given":"Preeti","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine Post Graduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0961-0369","authenticated-orcid":false,"given":"Divjot Singh","family":"Lamba","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine Post Graduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3901-6969","authenticated-orcid":false,"given":"Sunil","family":"Taneja","sequence":"additional","affiliation":[{"name":"Department of Hepatology Post Graduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3590-2664","authenticated-orcid":false,"given":"Ajay","family":"Duseja","sequence":"additional","affiliation":[{"name":"Department of Hepatology Post Graduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7415-4665","authenticated-orcid":false,"given":"Ratti Ram","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine Post Graduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-008-9106-x"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.04.021"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27077"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314641"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2024.04.018"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2024.03.026"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/LVT.0000000000000231"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-024-10773-4"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.22043"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.08.018"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.22010"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.70018"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-017-9816-z"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.06.005"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(78)90401-8"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0011-3840(64)80003-4"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-010-1377-0"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1594.1994.tb02217.x"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-014-9580-2"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14806"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.22033"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2021.07.010"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-015-9667-4"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e3181faefa3"},{"key":"e_1_2_12_26_1","first-page":"256","article-title":"Good Tolerance of Citrate Accumulation due to Plasma Exchange Among Patients With Acute\u2010On\u2010Chronic Liver Failure: A Prospective, Observational Study","volume":"3","author":"Ma Y.","year":"2018","journal-title":"Canadian Journal of Gastroenterology and Hepatology"}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70102","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jca.70102","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T04:10:32Z","timestamp":1773029432000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.70102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/jca.70102"],"URL":"https:\/\/doi.org\/10.1002\/jca.70102","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"value":"0733-2459","type":"print"},{"value":"1098-1101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"2025-07-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70102"}}