{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T07:48:56Z","timestamp":1782460136277,"version":"3.54.5"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"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":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Acute\u2010on\u2010chronic liver failure (ACLF) is associated with significant morbidity and mortality. Plasma exchange (PE) is a primary intervention for toxin removal and the management of coagulopathy. Persistent global plasma shortages highlight the urgent need to develop and implement plasma\u2010sparing strategies that preserve therapeutic efficacy and safety. This retrospective cohort study was conducted on 134 patients at the Department of Gastroenterology, Yan'an Hospital of Kunming, from January 2022 to December 2024. Patients were diagnosed according to the guidelines of the Chinese Medical Association. All patients received DPMAS sequential PE and were assigned to two groups according to the volume of fresh frozen plasma: the low\u2010volume (600\u2013800\u2009mL) plasma group (DPMAS\u2009+\u2009LVP group,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200976) and the half\u2010volume (1000\u20131200\u2009mL) plasma group (DPMAS\u2009+\u2009HVP group,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200958). The primary outcome was 28\u2010day transplant\u2010free survival, while secondary outcomes included liver function, coagulation parameters, hematologic parameters, plasma consumption, hospitalization costs, and adverse events. The total bilirubin, serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, \u03b3\u2010glutamyl transferase, serum ammonia, coagulation profiles including prothrombin time activity, international normalized ratio, reaction time, maximum amplitude, and clinical severity scores (MELD\u2010Na, CLIF\u2010SOFA, and AARC\u2010ACLF score) showed significant improvement in both groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). No significant differences were observed between groups in bilirubin reduction (\n                    <jats:italic>p\u2009=<\/jats:italic>\n                    \u20090.695), coagulation profiles, hematologic parameters (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&gt;\u20090.05), or 28\u2010day survival rate (74% vs. 76%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.92). The DPMAS\u2009+\u2009LVP group achieved 40% plasma conservation (539\u2009mL vs. 1050\u2009mL) and reduced hospitalization costs (51\u2009632 CNY vs. 67\u2009152 CNY), compared to the HVP group (\n                    <jats:italic>p\u2009&lt;<\/jats:italic>\n                    \u20090.05). Adverse events were comparable in the DPMAS\u2009+\u2009HVP group and the DPMAS\u2009+\u2009LVP group (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&gt;\u20090.05). Multivariate analysis identified baseline MELD\u2010Na as an independent predictor of mortality (OR 1.13 per point, 95% CI 1.03 to 1.23,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.012), while PE volume was not significantly associated with mortality (adjusted OR for HVP 2.06,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.271). DPMAS sequential LVP is a feasible and resource\u2010efficient strategy with comparable short\u2010term efficacy and a favorable safety profile compared to HVP. Prospective studies are needed to validate these results.\n                  <\/jats:p>","DOI":"10.1002\/jca.70144","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T10:11:01Z","timestamp":1781172661000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low\u2010Volume Plasma Exchange Following Double Plasma Molecular Adsorption System in Acute\u2010On\u2010Chronic Liver Failure: A Plasma\u2010Sparing Strategy"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0800-4554","authenticated-orcid":false,"given":"Xujia","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Gastroenterology The Affiliated Yan'an Hospital of Kunming Medical University  Kunming China"},{"name":"Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linna","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The First People's Hospital of Yunnan Province  Kunming China"},{"name":"The Affiliated Hospital of Kunming University of Science and Technology  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Yan'an Hospital of Kunming Medical University  Kunming China"},{"name":"Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Yan'an Hospital of Kunming Medical University  Kunming China"},{"name":"Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7862-2984","authenticated-orcid":false,"given":"Feng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Yan'an Hospital of Kunming Medical University  Kunming China"},{"name":"Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Yan'an Hospital of Kunming Medical University  Kunming China"},{"name":"Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Yan'an Hospital of Kunming Medical University  Kunming China"},{"name":"Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7802-9418","authenticated-orcid":false,"given":"Rong","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Yan'an Hospital of Kunming Medical University  Kunming China"},{"name":"Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province  Kunming China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Yan'an Hospital of Kunming Medical University  Kunming China"},{"name":"Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province  Kunming 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