An interventional study of DPMAS and standard treatment in Acute-On-Chronic Liver Failure and Acute on Chronic Hepatic Failure, sponsored by Chulalongkorn University. Recruiting at 1 site in Thailand. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-06-16.
Sponsored by Chulalongkorn University · Not applicable, Interventional, and Treatment
Acute liver failure patients posed high mortality rate despite receiving standard therapy. The severity and mortality even higher in patients with underlying liver disease. Acute liver failure cause hyperinflammatory response in early stage and immunoparalysis in later stage. The surge of proinflammatory cytokines leads to multiorgan failure and more liver injury. Subsequent immunoparalysis may lead to lethal secondary infections.
Liver support system had been used in acute and acute ontop chronic liver disease for last several decades. Double plasma molecular adsorption system (DPMAS) is one of the promising non-biological liver support system that have been extensively investigated in acute ontop chronic liver failure from hepatits B viral. DPMAS circuit consist of BS330 (bilirubin adsorber) and HA330 (Cytokines adsorber). Thus, DPMAS can also remove various cytokines. The effect of DPMAS on immune function in these patients has not been explored.
Recent randomized controlled trial by Srisawat et al. demonstrated improvement of mHLA-DR in septic shock patients who received polymyxin B extracorporeal therapy compare to control arm. Since liver failure show change of immunological profile resemble to sepsis. Investigators proposed that removal of toxic liver toxins and lethal cytokines by DPMAS will improve immunological profiles in acute ontop chronic liver failure patients.
Investigators plan to conduct a randomized controlled trial in acute ontop chronic liver failure patients who admitted to intensive care unit. Investigators plan to compare the immunomodulatory effects of DPMAS with standard treatments.
169 studies on the registry are indexed under Acute-On-Chronic Liver Failure; 57 are open to participants now.
This study's planned enrollment of 40 is below the median of 73 across 99 interventional studies indexed under Acute-On-Chronic Liver Failure.
Browse Acute-On-Chronic Liver Failure studies →Chulalongkorn University is the lead sponsor of 312 studies on the registry; 59 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Intervention group will receive DPMAS extracorporeal treatment one session per day for 3 consecutive days plus standard therapy. We plan to use blood flow rate of 100-120 ml/hour with filtration fraction for plasma separation of 25-30%. DPMAS circuit consist of Plasmaflo OP cartridge (Asahi Medical, Tokyo, Japan), Ion exchange resin hemoperfusion cartridge (BS330; Jafron, Zhuhai City, China), and Neutral adsorption resin hemoperfusion cartridge (HA330-II; Jafron, Zhuhai City, China) We do not use any anticoagulant.
Device: DPMAS · Other: standard treatment
Standard treatment according to EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure 2017
Other: standard treatment
DPMAS circuit consist of Plasmaflo OP cartridge (Asahi Medical, Tokyo, Japan), Ion exchange resin hemoperfusion cartridge (BS330; Jafron, Zhuhai City, China), and Neutral adsorption resin hemoperfusion cartridge (HA330-II; Jafron, Zhuhai City, China)
standard treatment according to EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure 2017.
mHLA-DR expression
mHLA-DR expression
Time frame: 7 days
survival rate
survival rate
Time frame: 28 days
Reduction of total bilirubin
Reduction of total bilirubin
Time frame: 7 days
hepatic encephalopathy grading
hepatic encephalopathy grading
Time frame: 28 days
subsequent bacterial infection
subsequent bacterial infection
Time frame: 28 days
CD11b expression
CD11b expression
Time frame: 7 days
Plan to share: Undecided
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Acute-On-Chronic Liver Failure→
Chulalongkorn University