Controlled Trial of Exchange-Transfusion Therapy in Fulminant Hepatitis

Redeker, A G; Yamahiro, HarryS.

doi:10.1016/s0140-6736(73)91220-8

Cited by 139 publications

(47 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the study of R edeker and Y am ah iro [5] surprisingly all patients, except one, died very fast before the second transfusion could be started and it is not clear whether the deaths were due to a 'coma dépassé' or other complications. In our group, the pa tients received as a mean 3.6 transfusions before they died or 4.2 before they became conscious.…”

Section: Discussionmentioning

confidence: 98%

Discriminative and Prognostic Signs in Acute Hepatic Coma, Treated by Exchange Transfusions

Demedts¹,

Groote²,

Vandamme³

et al. 1974

Digestion

View full text Add to dashboard Cite

Discriminative and prognostic signs in 14 patients with acute hepatic coma, treated by exchange transfusion and permanent intensive care are described. Five patientssurvived and in none of them was there evolution towards cirrhosis. Nine patients diedduring the therapy, without any temporary clinical improvement. The clinical encephalopathy was initially very similar in both groups. Other parameters were, however, different and might have a prognostic value. The arterial blood ammonia and prothrombinvalue were initially more disturbed and improved only very partially with treatment in thegroup with lethal outcome. The EEG abnormalities were also more pronounced in the latter group; none of the patients with an EEG pattern 4b survived. The histological examination of liver specimens revealed more extensive necrosis with interlobular confluence inthe patients who died.

show abstract

Section: Discussionmentioning

confidence: 98%

Discriminative and Prognostic Signs in Acute Hepatic Coma, Treated by Exchange Transfusions

Demedts¹,

Groote²,

Vandamme³

et al. 1974

Digestion

View full text Add to dashboard Cite

show abstract

“…9,11,22,[32][33][34][35][36]38 Only 1 trial reported blinded-outcome assessment. 38 Two trials were published as abstracts.…”

Section: Methodological Quality and Publication Status Of Included Trmentioning

confidence: 99%

“…Twelve randomized trials on artificial or bioartificial support systems vs standard medical therapy were included in the primary analyses (TABLE 1). 9,11,12,22,[31][32][33][34][35][36][37][38] …”

Section: Identification Of Eligible Trialsmentioning

confidence: 99%

“…Two trials 36,38 assessed the molecular adsorbent recirculating system, which is based on hemodiabsorption with albumin. The remaining artificial systems were whole-blood exchange, 22 charcoal hemoperfusion, 31 and plasma exchange with hemoperfusion. 37 Two trials assessed bioartificial systems based on human liver-derived tumor cells (the extracorporeal liver assist device), 11 or porcine hepatocytes (the HepatAssist device).…”

Section: Characteristics Of Patients and Interventionsmentioning

confidence: 99%

See 1 more Smart Citation

Artificial and Bioartificial Support Systems for Acute and Acute-on-Chronic Liver Failure

Kjaergard¹,

Liu²,

Als‐Nielsen³

et al. 2003

JAMA

349

159

View full text Add to dashboard Cite

Context Artificial and bioartificial support systems may provide a "bridge" for patients with severe liver disease to recovery or transplantation.Objective To evaluate the effect of artificial and bioartificial support systems for acute and acute-on-chronic liver failure.Data Sources Randomized trials on any support system vs standard medical therapy were included irrespective of publication status or language. Nonrandomized studies were included in explorative analyses. Trials were identified through electronic searches (Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Library, MEDLINE, EMBASE, and the Chinese Medical Database), bibliographies, and contact with experts. Searches were conducted of the entire databases through September 2002.Study Selection Of 528 references identified, 12 randomized trials with 483 patients were included. Eight nonrandomized studies were included in explorative analyses. Data Extraction Data were extracted and trial quality was assessed independently by 3 reviewers (L.L.K., J.L., B.A-N.). The primary outcome measure was all-cause mortality. Results were combined on the risk ratio (RR) scale. Random-effects models were used. Sources of heterogeneity were explored through meta-regression and stratified meta-analyses. Data SynthesisOf the 12 trials included, 10 assessed artificial systems for acute or acute-on-chronic liver failure and 2 assessed bioartificial systems for acute liver failure. Overall, support systems had no significant effect on mortality compared with standard medical therapy (RR, 0.86; 95% confidence interval [CI], 0.65-1.12). Meta-regression indicated that the effect of support systems depended on the type of liver failure (P=.03). In stratified meta-analyses, support systems appeared to reduce mortality by 33% in acute-on-chronic liver failure (RR, 0.67; 95% CI, 0.51-0.90), but not in acute liver failure (RR, 0.95; 95% CI, 0.71-1.29). Compared with randomized trials, nonrandomized studies produced significantly larger estimates of intervention effects (P=.01). ConclusionThis review suggests that artificial support systems reduce mortality in acute-on-chronic liver failure compared with standard medical therapy. Artificial and bioartificial support systems did not appear to affect mortality in acute liver failure.

show abstract

“…Random trials of exchange blood transfusions were done in the 1960s and early 1970s [18][19][20], but these ended when a controlled trial in 1973 by Redeker and Yamahiro [21] showed no effect on mortality.…”

Section: Exchange Transfusion and Plasma Exchangementioning

confidence: 99%

Review of Support Systems Used in the Management of Fulminant Hepatic Failure

McGuire¹,

Sielaff

Nyberg

et al. 1995

Dig Dis

View full text Add to dashboard Cite

Fulminant hepatic failure has an exceedingly high mortality. Liver transplantation is the treatment option of choice. Unfortunately, one-third of patients with fulminant hepatic failure die awaiting a donor liver. For over 35 years attempts to remove or dilute putative toxins in the blood have been unsuccessful in improving survival rates. The use of biocompatible interfaces with blood or plasma and current hepatocyte culture techniques have led to the development of new support systems. This generation of bioartificial livers will hopefully provide the necessary hepatic functions and prevent many of the complications associated with fulminant hepatic failure. This paper will review the support systems tried and currently under investigation, with an emphasis on bioartificial livers.

show abstract

Controlled Trial of Exchange-Transfusion Therapy in Fulminant Hepatitis

Cited by 139 publications

References 7 publications

Discriminative and Prognostic Signs in Acute Hepatic Coma, Treated by Exchange Transfusions

Discriminative and Prognostic Signs in Acute Hepatic Coma, Treated by Exchange Transfusions

Artificial and Bioartificial Support Systems for Acute and Acute-on-Chronic Liver Failure

Review of Support Systems Used in the Management of Fulminant Hepatic Failure

Contact Info

Product

Resources

About