Effect of plasma exchange with albumin replacement on albumin functionality and organ dysfunction in acute-on-chronic liver failure

•Acute-on-chronic liver failure (ACLF) is characterized by organ failure(s) and high short-term mortality.•This pilot study investigated the effects of plasma exchange with albumin 5% (PE-A5%) in patients with ACLF.•PE-A5% increased albumin levels and improved albumin function (binding and antioxidant capacity) in this setting.•PE-A5% improved systemic hemodynamics, renal, cerebral, and liver functions, and some inflammatory parameters.•Safety, feasibility, and tolerability of PE-A5% in patients with ACLF was confirmed.