Combined use of non-biological artificial liver treatments for patients with acute liver failure complicated by multiple organ dysfunction syndrome

Abstract

BACKGROUND: Acute liver failure (ALF) caused by viral and non-viral hepatitis is often accompanied with severe metabolic disorders, the accumulation of toxic substances and continuous release and accumulation of a large number of endogenous toxins and inflammatory mediators. The present study aimed to investigate the effects of various combined non-biological artifi cial liver treatments for patients with acute liver failure (ALF) complicated by multiple organ dysfunction syndrome (MODS). METHODS:Thirty-one patients with mid-or late-stage liver failure complicated by MODS (score 4) were randomly divided into three treatment groups: plasmapheresis (PE) combined with hemoperfusion (HP) and continuous venovenous hemodiafiltration (CVVHDF), PE+CVVHDF, and HP+CVVHDF, respectively. Heart rate (HR) before and after treatment, mean arterial pressure (MAP), respiratory index (PaO 2 /FiO 2 ), hepatic function, platelet count, and blood coagulation were determined. RESULTS:Signifi cant improvement was observed in HR, MAP, PaO 2 /FiO 2 , total bilirubin (TBIL) and alanine aminotransferase (ALT) levels after treatment (P<0.05). TBIL and ALT decreased more signifi cantly after treatment in the PE+CVVHDF and PE+HP+CVVHDF groups (P<0.01). Prothrombin time (PT) and albumin were signifi cantly improved only in the PE+CVVHDF and PE+HP+CVVHDF groups (P<0.05). TBIL decreased more significantly in the PE+HP+CVVHDF group than in the HP+CVVHDF and PE+CVVHDF groups (P<0.05). The survival rate of the patients was 58.1% (18/31), viral survival rate 36.4% (4/11), and non-viral survival rate 70% (14/20). CONCLUSION:Liver function was relatively improved after treatment, but PE+HP+CVVHDF was more efficient for the removal of toxic metabolites, especially bilirubin. The survival rate was signifi cantly higher in the patients with non-viral liver failure than in those with viral liver failure.

Therapeutic effect of double plasma molecular adsorption system and sequential half‐dose plasma exchange in patients with HBV‐related acute‐on‐chronic liver failure

“…In addition, the ALSS with a single mode of action may not be sufficient to meet the treatment needs for the patients, so combination of different types of ALSS, using their respective advantages to complement each other, has become a favorable choice . Li et al applied a combination of PE, hemoperfusion (HP) and continuous veno‐venous hemodialysis filtration (CV‐VHDF) in patients with ALF, and the results showed that PE + HP + CVVHDF could effectively remove bilirubin . A study illustrated that PE combined with bilirubin adsorption can effectively remove toxins to improve liver function .…”

“…23,24 Li et al applied a combination of PE, hemoperfusion (HP) and continuous veno-venous hemodialysis filtration (CV-VHDF) in patients with ALF, and the results showed that PE + HP + CVVHDF could effectively remove bilirubin. 25 A study illustrated that PE combined with bilirubin adsorption can effectively remove toxins to improve liver function. 26 Similarly, the results of the present study showed that DPMAS+PE had a significantly higher ability to reduce bilirubin than PE alone.…”

Sequential versus mono double plasma molecular adsorption system in acute-on-chronic liver failures: A propensity-score matched study

“…Previous studies reported that PE and DPMAS could resulted in significant reduction in ALT, AST, TBIL, DBIL, TBA, and albumin levels in ACLF patients. 8,9,18,19 Li et al 5 reported that PE combined with HP could decrease TBIL and ALT levels more significantly than HP or PE alone. Therefore, different combinations of non-bioartificial therapies were more effective in improving severe metabolic disorders and removing accumulated toxic substances and inflammatory mediators caused by serious damage of liver cells.…”

“…Plasma exchange (PE) using fresh frozen plasma (FFP) as replacement fluid is conventionally performed as the main treatment of liver failure for many years. PE can successfully remove both protein-bound and large molecules such as inflammatory mediators 5,6 ; but it is mainly restricted by increased risk of allergies and infections due to exposure to exogenous plasma. 7 Double plasma molecular adsorption system (DPMAS) is a modified hemoperfusion model that combines anion exchange resin and neutral macroporous resin.…”

A 15-Year Retrospective Study of Supportive Extracorporeal Therapies Including Plasma Exchange and Continuous Venovenous Hemodiafiltration of 114 Adults with Acute Liver Failure Awaiting Liver Transplantation

“…Supportive extracorporeal therapy is a treatment that provides temporary and partial replacement of liver function, while also removing harmful substances and supplying beneficial biological substances to promote the regeneration and functional recovery of the patient’s liver cells [ 10 ]. However, since the effectiveness of supportive extracorporeal therapy alone is limited, there is growing interest in exploring different combinations of non-biological artificial liver methods [ 11 , 12 ]. Continuous venovenous hemodiafiltration and plasma exchange are used in conjunction as a bridging treatment in recovery without liver transplant and to extend care until liver transplant.…”