Acute-on-chronic liver failure (ACLF) is a severe form of chronic liver disease associated with multi-system organ dysfunction and high short-term mortality. High-volume plasma exchange (PLEX) is one of the therapeutic measures that improves prognosis. We present the case of a 32-year-old man with alcohol-related liver disease who was admitted with acute decompensation, including coagulopathy, hepatic encephalopathy, and acute kidney injury precipitated by alcoholic hepatitis. Despite standard medical treatment, the inflammatory state did not improve. High-volume PLEX was initiated, and five cycles were completed following a multidisciplinary discussion. This intervention improved the clinical and biochemical status of the patient. Pathologically, ACLF is characterized by systemic inflammation, with high levels of cytokines released into the circulation leading to organ failure. In resource-limited settings where liver transplantation is not available, PLEX is emerging as a promising modality, offering biochemical improvement and enhanced survival. PLEX works by eliminating accumulated toxins in ACLF, aiding the recovery of the failing liver and creating a suitable environment for liver regeneration.
Keywords: acute-on-chronic liver failure (aclf); alcohol-related liver disease; he: hepatic encephalopathy; hrs-aki; severe alcoholic hepatitis; therapeutic plasma exchange (tpe).
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