THERAPEUTIC PLASMA EXCHANGE-INDUCED SHIFTS IN BILE SALT COMPOSITION IN ALCOHOL-ASSOCIATED HEPATITIS: INSIGHTS INTO MECHANISMS AND THERAPEUTIC POTENTIAL

Introduction and Objectives

Severe alcohol-associated hepatitis (sAH) is an acute liver disease with high mortality. While plasma exchange (TPE) improves survival in ACLF, its role in sAH is unknown. This pilot study evaluated TPE’s effect on bile acid (BA) profiles and clinical outcomes.

Materials and Methods

We retrospectively analyzed 11 patients with sAH treated with five TPE sessions at a center in Banská Bystrica, Slovakia. Serum and effluent BA concentrations were quantified by liquid chromatography-tandem mass spectrometry. Clinical and laboratory data were collected pre- and post-TPE.

Results

The median age was 48.7 years; two (18%) were women. Median MELD decreased from 34.3 to 24.6 post-TPE. Five patients (45.5%) died. BA composition between serum and effluent was similar (p=0.689), but UDCA concentrations differed significantly (399.6 vs. 669.4 ng/mL; p=0.04). Before TPE, deceased patients had higher levels of total BA (75,213 vs. 44,736 ng/mL; p=0.026), glycine-conjugated BA (49,769 vs. 28,350 ng/mL; p=0.013), total conjugated BA (73,837 vs. 43,881 ng/mL; p=0.026), G-UDCA (19,038 vs. 7,819 ng/mL; p=0.021), LCA (6.34 vs. 4.62 ng/mL; p=0.048), and G-CDCA (21,132 vs. 11,370 ng/mL; p=0.012). In the effluent, deceased patients had higher total unconjugated BA (3,512 vs. 871 ng/mL; p=0.032), UDCA (3,353 vs. 520 ng/mL; p=0.026), and DCA (25.9 vs. 17.5 ng/mL; p=0.047).

Conclusions

Patients who died had distinct BA profiles before and after TPE. These findings suggest TPE modifies circulating BA, and specific profiles may predict poor outcomes. Larger studies are needed to clarify their clinical relevance.

Conflict of interest: None

Distribution of bile salts in pre-TPE plasma and post-TPE effluent.