Plasma Adsorption Using Bilirubin‐Adsorbent Materials as a Treatment for Patients with Hepatic Failure

Abstract

In order to achieve a higher degree of improvement in patients with postoperative hepatic failure, the effects of plasma adsorption (PA) using a serial connection of noncoated charcoal (N 350) and a new bilirubin adsorbent material, styrenedivinylbenzene (BR350), were investigated both experimentally and clinically. After in vitro perfusion of high bilirubin containing plasma through these columns for 3 hours, total bilirubin levels were drastically reduced to 21% of the preperfusion level in the serial connection of N 350 and BR 350, while it remained high at over 40% in the single use of each column. Total branched chain and aromatic amino acid levels were also drastically reduced in the serial connection of these columns to 50, 40, and 7%, respectively, while the total amino acid levels remained high at 87% in the single use of BR 350. The combination of these columns enhanced rather than interfered with one another. Patients who received this treatment achieved an initial reduction of plasma total bilirubin and aromatic amino acids of 57 _t 6 and 84 f 7, respectively. Although the Iongterm prognosis for these patients was negative, improvement of clinical and laboratory findings were actually obtained by this treatment. This PA system could provide a possibility for an improved supportive therapy for hepatic failure, especially for patients with hepatic coma and hyperbilirubinemia.

Albumin Regeneration in Liver Support—Comparison of Different Methods

“…Hemoperfusion over charcoal showed no advantage over standard treatment in a large RCT previously (33). The side‐effects probably caused both the plasma perfusion over sorbents (bilirubin adsorption) and Prometheus methods to omit the charcoal columns that were part of the original treatment concepts (14,20), although the mere use of an anion exchanger or the addition of a neutral resin apparently go along with a decrease in efficacy (14,34). MARS is the only system which can make use of the high‐binding capacity of charcoal while not having to accept the unwanted effects of unselectivity as no plasmafraction is passed over the sorbents as in bilirubin adsorption or Prometheus.…”

“…4). It was first used in the mid-1980s by Japanese groups for the treatment of liver failure with intractable jaundice (14).…”

“…No positive effect on Fisher index (branched chain amino acids (BCAA)/aromatic amino acids (AAA)) was observed with BR350 alone, but in patients treated with the combination of columns, a clear impact on bilirubin and AAA was noted. However, a clinical course was unfavorable (14).…”

Renal Replacement Therapy in Special Settings: Extracorporeal Support Devices in Liver Failure

“…Numerous small, uncontrolled trials have been performed with various forms of plasmapheresis mainly demonstrating improvement in hepatic encephalopathy (HE) and hemodynamic parameters but not difference in mortality (18–25). Plasma filtration absorption was first used in the 1989 for the treatment of liver failure with intractable jaundice (26). Since then, multiple uncontrolled observations have been published (27–32).…”

Non-ionic macroporous polystyrene adsorbents for removal of serum toxins in liver failure by hemoperfusion

“…However, the shortage of available donor organs is prompting scientists to look for alternative methods. Therefore, in the past several decades, various liver assist devices have been introduced to either sustain liver function long enough to permit the organ's regeneration and functional recovery or to bridge patients to transplantation (Morimoto et al 1989, Usami et al 1995.…”