Automated plasmapheresis for management of hepatotoxic reactions to chemotherapy in pulmonary tuberculosis patients with multiple drug resistance including those with concurrent viral hepatitis

The objective of the study: to assess the efficiency of therapeutic discrete automated plasmapheresis in the management of hepatotoxic reactions, developed in tuberculosis patients with multiple and extensive drug resistance, including those with concurrent viral hepatitis.

Subjects and methods. 136 patients suffering from respiratory tuberculosis with multiple and extensive drug resistance were enrolled in the study. 56 of them had viral hepatitis: 3 (5.4%) patients suffered from hepatitis B, 49 (87.5%) from hepatitis С and 4 (7.1%) had both hepatitis В + С. After the initiation of chemotherapy, out of 56 patients with viral hepatitis, 36 (64.3%) developed hepatotoxic reactions which was statistically significantly more frequent versus 23 (28.8%) patients out of 80 ones without viral hepatitis, p < 0.01. Patients with hepatotoxic reactions were randomly divided into two groups (29 and 30 patients), and plasmapheresis was used to manage drug-induced liver disorders in one of them.

Results. This method was used in 29 patients and it allowed managing hepatotoxic reactions without cancellation of chemotherapy. In the group where no plasmapheresis was used, chemotherapy was temporarily discontinued in 12 (40.0%) out of 30 patients from 6 to 20 days.

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