Selective Plasma Exchange With Dialysis in Patients With Acute Liver Failure

Nakae, Hajime; Igarashi, Toshiko; Tajimi, Kimitaka

doi:10.1111/j.1744-9987.2012.01112.x

Cited by 19 publications

(30 citation statements)

References 18 publications

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“…Selective plasma exchange (SePE) using a selective membrane separator is a modified method of simple plasma exchange (PE) . Nakae et al.…”

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“…Selective plasma exchange (SePE) using a selective membrane separator is a modified method of simple plasma exchange (PE) (1,2). Nakae et al reported that SePE with dialysis can be a useful modality for the treatment of acute liver failure (1) and drug poisoning (2). Evacure EC-4A10 (EC-4A) (Kawasumi Laboratories, Tokyo, Japan) is a high cutoff membrane plasma separator that has a smaller pore size (0.03 μm) of 1/10, compared with the conventional membrane plasma separators such as Plasmaflo OP-05W (OP-05) (Asahi Kasei Medical, Tokyo, Japan).…”

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Removal Characteristics of Immunoglobulin G Subclasses by Conventional Plasma Exchange and Selective Plasma Exchange

et al. 2015

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Selective plasma exchange (SePE) using a selective membrane separator is a modified method of simple plasma exchange (PE). Immunoglobulin G (IgG) subclass distribution is one of the important immunological characteristics of IgG. However, there is little information regarding the removal characteristics of IgG subclasses by SePE and conventional PE. Here, we investigated the removal ratio of IgG subclasses by PE and SePE in seven patients with immunological disorders. When the mean processed volume was 0.88 plasma volume (PV) (corresponding to 2.12 L), the mean percent reductions by PE were as follows: IgG, 63.2%; IgG1, 64.5%; IgG2, 64.0%; IgG3, 61.4%; and IgG4, 69.5%. When the mean processed volume was 1.18 PV (corresponding to 2.98 L), the mean percent reductions by SePE were as follows: IgG, 51.6%; IgG1, 55.3%; IgG2, 52.0%; IgG3, 53.7%; and IgG4, 64.6%. In both PE and SePE, using albumin solution as the supplementary fluid, IgG was effectively eliminated regardless of IgG subclasses.

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“…Selective plasma exchange (SePE) using a selective membrane separator is a modified method of simple plasma exchange (PE) . Nakae et al.…”

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Removal Characteristics of Immunoglobulin G Subclasses by Conventional Plasma Exchange and Selective Plasma Exchange

et al. 2015

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“…Selective plasma exchange has showed beneficial effects in the management of acute hepatic encephalopathy in patients with liver failure [24]. In a recent study looking at the effect of plasma exchange on four patients with ALF, a significant decrease in hepatic encephalopathy and IL-18 levels was reported with plasma exchange [25].…”

Section: Hepatic Encephalopathy In Aclfmentioning

confidence: 98%

Liver dialysis in acute-on-chronic liver failure: current and future perspectives

et al. 2014

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Patients with acute-on-chronic liver failure (ACLF) are known to have a very high mortality rate as the majority of these patients succumb to multiorgan failure. Liver transplant remains the only option for these patients; however, there are problems with its availability, cost and also the complications and side effects associated with immunosuppression. Unlike advanced decompensated liver disease, there is a potential for hepatic regeneration and recovery in patients with ACLF. A liver support system, cell or non-cell based, logically is likely to provide temporary functional support until the donor liver becomes available or the failing liver survives the onslaught of the acute insult and spontaneously regenerates. Understanding the pathogenesis of liver failure and regeneration is essential to define the needs for a support system. Removal of hepatotoxic metabolites and inhibitors of hepatic regeneration by liver dialysis, a non-cell-based hepatic support, could help to provide a suitable microenvironment and support the failing liver. The current systems, i.e., MARS and Prometheus, have failed to show survival benefits in patients with ACLF based on which newer devices with improved functionality are currently under development. However, larger randomized trials are needed to prove whether these devices can enable restoration of the complex dysregulated immune system and impact organ failure and mortality in these patients.

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“…PE has played a major role in rescue treatment of critically ill patients and patients with autoimmune diseases (Inoue et al, 2010;Qiu et al, 2011;Qu et al, 2011). It is especially valuable in diseases associated with liver failure because of its demonstrated irreplaceable role in clearing toxins from the liver (Nakae et al, 2012). Theoretically, PE could clear almost all toxins from the plasma, especially those that couple tightly with plasma proteins (Schutt et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Plasma exchange parameter selection and safety observation of children with severe ricinism

Chen

Nie

et al. 2015

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to investigate the selection of plasma exchange (PE) parameters and the safety of children with severe ricinism. The PE parameters and heparin dosage in 7 children with severe ricinism were recorded, and changes in the patients' vital signs and coagulation function were monitored before and after PE. All patients successfully completed PE. The speed of blood flow was 50-80 mL/min, speed of exchange flow was 600-800 mL/h, and isolating rate of blood plasma was 12.5-19.05%. Transmembrane pressure was stable at approximately 100 mmHg, and venous pressure was stable at approximately 95 mmHg. The first dose of heparin was 0.39 ± 0.04 mg/ kg, and the maintaining heparin dose was 0.40 ± 0.05 to 0.22 ± 0.03 mg·kg -1 ·h -1 . During the PE process, mean arterial pressure, heart rate, respiratory rate, and pulse oxygen saturation were steady. After PE, the activated partial thromboplastin time and thrombin time prolonged to 4170 G.M. Chen et al. ©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (2): 4169-4176 (2015) 2-3 times greater than that before PE. However, no bleeding tendency was seen. For children with severe ricinism, the choice of PE to eliminate the toxin from blood, tissues, and organs was safe and effective.

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Selective Plasma Exchange With Dialysis in Patients With Acute Liver Failure

Cited by 19 publications

References 18 publications

Removal Characteristics of Immunoglobulin G Subclasses by Conventional Plasma Exchange and Selective Plasma Exchange

Removal Characteristics of Immunoglobulin G Subclasses by Conventional Plasma Exchange and Selective Plasma Exchange

Liver dialysis in acute-on-chronic liver failure: current and future perspectives

Plasma exchange parameter selection and safety observation of children with severe ricinism

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