Continuous Veno-Venous Hemodiafiltration and Plasma Exchange in Infantile Acute Liver Failure

Ide, Kentaro; Muguruma, Takashi; Shinohara, Mafumi; Toida, Chiaki; Enomoto, Yuki; Matsumoto, Shotaro; Aoki, Kazunori; Fukuda, Akira; Sakamoto, Seisuke; Kasahara, Mureo

doi:10.1097/pcc.0000000000000511

Cited by 57 publications

(50 citation statements)

References 24 publications

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“…Several studies to date have suggested improved survival in liver failure patients treated with CRRT, with the possibility that the greatest benefit is achieved with high-intensity therapy [2,7,9,10,13,14.] These studies, however, have been of limited quality and have been almost entirely single-center, retrospective cohort studies.…”

Section: Discussionmentioning

confidence: 99%

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Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction

et al. 2017

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Aims: To study the association between higher versus lower continuous renal replacement therapy (CRRT) intensity and mortality in critically ill patients with combined acute kidney injury and liver dysfunction. Methods: Post-hoc analysis of patients with liver dysfunction (Sequential Organ Failure Assessment liver score ≥2 or diagnosis of liver failure/transplant) included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial. Results: Of 444 patients, 210 (47.3%) were randomized to higher intensity (effluent flow 40 mL/kg/h) and 234 (52.7%) to lower intensity (effluent flow 25 mL/kg/h) therapy. Overall, 79 and 86% of prescribed effluent flow was delivered in the higher-intensity and lower-intensity groups, respectively (p < 0.001). In total, 113 (54.1%) and 120 (51.3%) patients died in each group. On multivariable Cox regression analysis, we found no independent association between higher CRRT intensity and mortality (HR 0.93, 95% CI 0.70-1.24; p = 0.642). Conclusions: In RENAL patients with liver dysfunction, higher CRRT intensity was not associated with reduced mortality.

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Section: Discussionmentioning

confidence: 99%

“…In such patients, intensive correction of ammonia levels is possible using CRRT, and has been associated with improved survival [7,8]. Furthermore, high volume hemofiltration has been associated with improved survival in children with liver failure [9,10]. …”

Section: Introductionmentioning

confidence: 99%

Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction

et al. 2017

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“…We previously reported our single-center experience with patients with acute liver failure [13, 14]. Of the 65 patients treated at our center for acute liver failure between November 2005 and December 2015, 54 patients (83.1%) received liver transplants.…”

Section: Liver Transplantsmentioning

confidence: 99%

Current status of pediatric transplantation in Japan

et al. 2017

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Brain-dead donor organ transplantation has been available to children in Japan since the 2010 revision of the Organ Transplant Law. Of the 50–60 brain-dead donor organ transplants performed annually in Japan, however, very few (0–4 per year) are performed in children. Again, while those receiving liver, heart, and kidney transplants are reported to fare better than their counterparts in the rest of the world, organ shortage is becoming a matter of great concern. Very few organs become available from brain-dead donors or are transplanted to adults if made available at all, with some children dying while on the brain-dead organ waiting list. Against this background, living-donor transplants, split-liver transplants, domino transplants, and hepatocyte transplants represent alternative modalities, each of which is shown to be associated with favorable outcomes. Challenges exist, include streamlining the existing framework for promoting organ donation for children and between children.

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“…Both CVVHDF and PE were initially carried out for all patients under mechanical ventilation to identify the precipitating cause of liver failure; once the cause of ALF was determined, specific therapy was initiated. The details of CVVHD and PE have been described elsewhere . During intubation, the severity of HE was continuously monitored by electroencephalogram.…”

Section: Methodsmentioning

confidence: 99%

“…In Japan, therapeutic apheresis and dialysis have been uniquely developed and established as artificial liver support therapy in a combination of continuous veno‐venous hemodiafiltration (CVVHDF) and plasma exchange (PE) . As the deceased organ donation rate in Japan has remained low, living donor LT has been mainly undertaken for patients refractory to the above treatment .…”

Section: Introductionmentioning

confidence: 99%

Sequential analysis of variable markers for predicting outcomes in pediatric patients with acute liver failure

Uchida

Sakamoto

Fukuda

et al. 2017

Hepatology Research

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Continuous Veno-Venous Hemodiafiltration and Plasma Exchange in Infantile Acute Liver Failure

Abstract: Our multidisciplinary approach for infants with acute liver failure achieved favorable outcomes. Further investigations are needed to examine the efficacy of the artificial liver support.

Cited by 57 publications

References 24 publications

Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction

Higher versus Lower Continuous Renal Replacement Therapy Intensity in Critically ill Patients with Liver Dysfunction

Current status of pediatric transplantation in Japan

Sequential analysis of variable markers for predicting outcomes in pediatric patients with acute liver failure

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