Therapeutic plasma exchange in amatoxin associated acute liver failure–results from the multi-center Amanita-PEX study
Authors' conclusion
In this real-world study, adjunctive use of PEX was associated with increased LTX-free-survival in patients with AT-ALF and HE grade ≥ 2.
Study context
- Population
- Patients with amatoxin-related acute liver failure (AT-ALF), 2013–2024
- Participants
- 111 patients · 25 centres
- Exposure
- Adjunctive plasma exchange (PEX) vs standard of care
- PEXn = 29
- Standard-of-care (SOC)n = 82reference
- Outcome
- LTX-free survival (composite endpoint:
- Death
- LTX) after ALF diagnosis
- Follow-up
- 28 days
Methodological detailsmulticentre, international
- Multicentre
- International
Main finding
As reported in the abstract
28-day LTX-free survival, all patients
- Not different between SOC and PEX
Observational data: associations, not effects.
Further findings
LTX-free survival, subgroup with maximal HE grade ≥ 2 (subgroup) · 28 days · Log-Rank-p = 0.060
P = 0.041
LTX-free survival after propensity-score matching · Log-Rank-p = 0.035 · propensity-score-matching
Gehan-Breslow-p = 0.036
HE grade ≥ 2 development
P = 0.021
| Outcome | HR for death or LTX within 28 days (95% CI) | P value | |
|---|---|---|---|
| LTX-free survival, subgroup with maximal HE grade ≥ 2 (subgroup) · 28 daysIndependently associated | 0.37 (0.19–0.73) | P = 0.004 | |
| 0.20.5125HR for death or LTX within 28 days (log scale) |
Original publication
Therapeutic plasma exchange in amatoxin associated acute liver failure–results from the multi-center Amanita-PEX study. Crit Care. Published 30 October 2025. doi:10.
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