Effects on Plasma Exchange on Functional Capacity of Serum Albumin, Circulatory Dysfunction, Renal and Cerebral Function in Cirrhotic Patients With "Acute-on-chronic Liver Failure"

Inclusion Criteria:

• Age between 18 and 80 years old
• Hepatic cirrhosis diagnosed by biopsy or clinical, analytic and ultra sound data.
• acute on chronic liver failure: defined by an acute deterioration in hepatic function produced in 2-4 weeks with jaundice (total serum bilirubin ≥ 5 mg/dl ) and hepatic encephalopathy (≥ grade 2) and/or renal insufficiency (serum creatinine ≥ 2 mg/dl)

Exclusion Criteria:

• Neoplasm disease including hepatocarcinoma which exceed Milan criteria (1 tumour > 5cm, up to 3 tumours <3 cm)
• Active bacterial or fungal infection with hemodynamic instability which require the utilization of vasoactive drugs at moderate dose (>0,5 μg/Kg/min of noradrenaline)
• Structural moderate to severe cardiopathy (Cardiac Index <2l/min/m2)
• Chronic renal insufficiency in treatment with haemodialysis
• Chronic moderate o severe pulmonary disease (maximum expiratory volume in a second <50%)
• Active transplant
• human immunodeficiency virus infection
• Pregnancy or lactation
• Acute respiratory distress syndrome (P02/Fi02< 200mm Hg) or acute lung injury (P02/Fi02< 300mm Hg)
• Hemodynamic instability (>0,5 μg/Kg/min of noradrenaline)
• Bleeding in the digestive tract in the previous 72h to the treatment
• Severe coagulopathy: INR ≥ 3.0 (Quick ≤ 20%) and/or platelets < 30000//mm3
• Extrahepatic cholestasis
• Hepatobiliary surgery in the last 6 months (except laparoscopic Cholecystectomy)
• Concentrations bilirubin ≥ 5mg/dl during the period above 4 weeks previous to inclusion
• Concomitant participation in an other clinical trial
• Drug addiction
• Mental status which does not allow the patient to understand the trial, with the exception of hepatic encephalopathy.