Multicenter Study of Plasma Diafiltration in Patients With Acute Liver Failure

Abstract

Plasma diafiltration (PDF) is a blood purification therapy in which simple plasma exchange (PE) is performed using a selective membrane plasma separator while the dialysate flows outside the hollow fibers. A prospective, multicenter study was undertaken to evaluate the changes in bilirubin, IL-18, and cystatin C, as well as the 28-day and 90-day survival rates, with the use of PDF according to the level of severity as measured by the Model for End-Stage Liver Disease (MELD) score. Twenty-one patients with liver failure were studied: 10 patients had fulminant hepatitis and PDF therapies were performed 28 times; 11 had acute liver failure with the therapy performed 96 times. Levels of total bilirubin, IL-18, and cystatin C decreased significantly after treatment. The 28-day survival rate was 70.0% and that at 90 days was 16.7%. According to the severity of the MELD score, each of the results compared well with the use of Molecular Adsorbent Recirculating System or Prometheus therapy. In conclusion, PDF appears to be one of the most useful blood purification therapies for use in cases of acute liver failure in terms of medical economics and the removal of water-soluble and albumin-bound toxins.

Efficacy of continuous plasma diafiltration therapy in critical patients with acute liver failure

“…Conventional PDF therapy is simple, less expensive, and results in fewer adverse events than other therapies. Consequently, this therapy has been demonstrated to be one of the most useful blood purification therapies for ALF patients . However, conventional PDF therapy, which is used intermittently throughout an 8‐h day, does not usually maintain hemodynamic stability.…”

“…PDF is a blood purification therapy in which simple PE is performed with a membrane plasma separator, while dialysate flows outside the hollow fibers . In ALF patients, PDF is a useful bridge therapy for liver regeneration or transplantation . However, PDF therapy is difficult to use in critically ill ALF patients with complicated multiple organ failure, especially in those with unstable hemodynamics.…”

Liver Support Systems—A Review

“…Other investigators have combined plasma exchange with continuous venovenous hemodiafiltration (CVVHDF) and reported improvement in metabolic complications, encephalopathy, and systemic inflammation. [44][45][46][47] In 90 patients randomized to plasma exchange with or without CVVHDF, hypernatremia and alkalosis were significantly less common in the combined group. 45 In another 15 patients, interleukin-6 and interleukin-8 removal was better in the combined modality group.…”

“…45 In another 15 patients, interleukin-6 and interleukin-8 removal was better in the combined modality group. 47 Finally, in 21 patients with acute liver failure, combined plasma exchange and CVVHDF significantly reduced levels of total bilirubin, interleukin-18, and cystatin C. 46 The 28-day survival was 70%. Based on patients' MELD scores, the survival rate was similar to those reported using either the MARS or the Prometheus system.…”

Plasma filtration with dialysis (plasma diafiltration) in critically ill patients with acute liver failure

“…We have developed a new system, plasma filtration with dialysis (plasma diafiltration (PDF)) [1],[2], and assessed its efficacy in multicenter analysis.…”