Critical Care Apheresis: Hepatic Failure

Fulminant hepatic failure is a rare, but often fatal complication of acute viral hepatitis. This condition, in absence of orthotopic liver transplantation (OLTx) surgery, is associated with a high mortality rate, despite the improvement of general intensive care. Plasma-exchange (PEx) therapy has been long used to treat FHF, in particular by removing toxic substances and correcting the severe coagulopathy. In this study we describe our experience with PEx treatment of FHF, beginning in 1982. Seventy patients affected with FHF due to various causes (HBV=40; cryptogenic/non-A, non-E=15; Amanita phalloides=8; other=7) were treated with PEx (altogether 348 sessions). Overall survival rate, comprising patients undergoing OLTx, was 51%, a little higher than what we observed in patients (N=49) treated solely by PEx, i.e., 41%. The best outcome predictor was FHF aetiology, owing to the good survival rate in patients with Amanita phalloides intoxication and the very poor prognosis of patients suffering from cryptogenic/non-A, non-E FHF. Moreover, the marked increase in prothrombin time and alpha-fetoprotein levels after 48 hours from admission was associated with a good prognosis, whereas the patient's age and coma grade were not clearly predictive of survival. Additionally, lymphocyte subpopulation, resulting in a CD4/CD8 ratio lower than 1.0 along with CD8 activation with HLA-DR strong expression, were associated with a high rate of mortality and morbidity. Our data indicate that PEx therapy can improve survival in patients with sufficient residual capacity of liver regeneration. Moreover, the identification of certain prognostic factors may be useful for the rational planning of therapeutic strategy in FHF.

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The Curative Effect of ALSS on 1-month Mortality in AoCLF Patients after 72 to 120 Hours

Chen

et al. 2007

Int J Artif Organs

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Background Hepatitis B virus (HBV)-related acute-on-chronic liver failure (AoCLF) is associated with a high mortality rate. An artificial liver support system (ALSS) creates a better environment for the self-regeneration of retained hepatocytes. Aim and Patients We investigated the curative effect of ALSS on 1-month mortality at 72–120 h post-ALSS in 289 AoCLF patients. Methods Of the 289 patients, 117 who survived for at least 1 month post-ALSS comprised the survival group; the remaining cases who died within 1 month served as controls. The improvements in laboratory data and clinical syndromes at 72–120 h post-ALSS were compared with those at 24 h. Results Total bilirubin, international normalized ratio, and creatinine levels, and encephalopathy were significantly improved at 24 h post-ALSS in both the groups (p<0.05); however, these variables showed deterioration at 72–120 h; a rebound occurred in the nonsurvivors (p>0.05). The improvements in these variables in the nonsurvivors were considerably smaller than those in the survivors (p<0.05), particularly at 72–120 h. One-month mortality was more accurately predicted by the logistic regression model at 72–120 h than at 24 h. Conclusions The prognosis of AoCLF patients was highly dependent on the improvement in encephalopathy, total bilirubin, international normalized ratio, and creatinine levels at 72–120 h post-ALSS. These variables are useful, therefore, as disease severity indexes to determine organ allocation priorities for liver transplant.

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Critical Care Apheresis: Hepatic Failure

Cited by 3 publications

References 15 publications

Effects of Artificial Liver Support System on Patients With Acute or Chronic Liver Failure

Effects of Artificial Liver Support System on Patients With Acute or Chronic Liver Failure

A Single Institution's Experience (1982–1999) with Plasma-Exchange Therapy in Patients with Fulminant Hepatic Failure

The Curative Effect of ALSS on 1-month Mortality in AoCLF Patients after 72 to 120 Hours

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