Use of Sorbent Columns and Haemofiltration in Fulminant Hepatic Failure

Abstract

Artificial liver support systems were developed to remove potential toxins from the circulation of patients with liver failure. A wide range of substances have been implicated in the toxic manifestations of liver failure, but no substance(s) has been identified as being of key importance. Charcoal haemoperfusion appeared to be beneficial in early studies, but when clinical trials were performed in 137 patients at King’s College Hospital there was no significant improvement in survival over intensive care alone. There have been many studies using haemodialysis/filtration systems, where an improvement in conscious level of the patient was reported, but the effect on survival was less clear. Recently in Japan, continuous high volume haemofiltration with the addition of plasma exchange has been used to support liver failure patients. In liver failure, endotoxaemia and increased cytokine production are important in the pathogenesis of circulatory failure. Experiments on adsorbents to remove cytokines have shown that Amberlite XAD-7 resin can remove significant amounts of tumour necrosis factor and interleukin-6 from liver failure plasma. The development of hepatocyte bioreactors with synthetic and metabolic function for clinical use will be a major advance in liver support.

Biocompatibility and Cytotoxic Evaluation of New Sorbent Cartridges for Blood Hemoperfusion

“…Sorbents are made of substances that adsorb on their surface other elements present in a fluid phase, thanks to their physical and chemical characteristics. In clinical practice, sorbents have been used to eliminate industrial, pharmacological, or endogenous toxins such as bilirubin or porphyrines [11, 12]. Several new sorbents specifically designed for particular diseases and target molecules to be removed have been proposed in the last years and applied in clinical trials [13-18].…”

Extracorporeal liver support by recirculating albumin dialysis: analysing the effect of the first clinically used generation of the MARSystem

“…Many of these pathogenic substances are transported in plasma by serum albumin and can therefore be cleared by conventional dialysis only by a less extend. This might by an explanation why the widely examined use of haemodialysis in the seventies and eighties has been abandoned as a method for artificial liver support (4).…”

Overview of Extracorporeal Liver Support Systems and Clinical Results

“…Continuous hemofiltration was applied to hepatic failure to avoid the high incidence of cerebral edema caused by rapid changes in plasma osmolality during the intermittent processes of hemodialysis and hemoperfusion. 5 Continuous hemofiltration has been used for body fluid control in cases of severe cardiac or pulmonary failure and has been proven to be capable of removing substances of molecular weight less than 10,000 dalton with PAN or poly(methyl methacrylate) (PMMA) membrane filters. In one clinical study, five patients with acute hepatic failure were treated by continuous hemofiltration with fluid replacement.…”