Effectiveness of Combining Plasma Exchange and Continuous Hemodiafiltration (Combined Modality Therapy in a Parallel Circuit) in the Treatment of Patients with Acute Hepatic Failure

Nakae, Hajime; Yonekawa, Chikara; Wada, Hiroshi; Asanuma, Yoshihiro; Sato, Tsutomu; Tanaka, Hiroyuki

doi:10.1046/j.1526-0968.2001.00380.x

Cited by 35 publications

(46 citation statements)

References 11 publications

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“…The therapeutic effects of 34 patients receiving plasma exchange plus hemoperfusion adsorption therapy showed coincidence with those receiving plasma exchange plus hemoperfusion adsorption therapy abroad [33,34] . That the patients' clinical symptoms after treatment showed temporary relief and liver function and coagulation function improved obviously indicates this therapy has temporary supportive effects on liver failure caused by severe viral hepatitis.…”

Section: Discussionmentioning

confidence: 95%

Effects of hemoperfusion adsorption and/or plasma exchange in treatment of severe viral hepatitis: A comparative study

He¹,

Wang²,

Wang³

et al. 2004

WJG

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AIM: Non-bioartificial liver has been applied to clinic for quite a long time, but the reported efficacy has been very different. The aim of this study was to compare the efficacy and safety of hemoperfusion adsorption, plasma exchange and plasma exchange plus hemoperfusion adsorption in treatment of severe viral hepatitis. METHODS:Seventy-five patients with severe viral hepatitis were treated with hemoperfusion adsorption therapy (24 cases), plasma exchange therapy (17 cases) and plasma exchange plus hemoperfusion adsorption therapy (34 cases). The data of liver function, renal function, blood routine test, prothrombin time (PT) and prothrombin activity (PTa) preand post-therapy were analyzed. RESULTS:Clinical symptoms of patients improved after treatment. The levels of aminotransferase, total bilirubin, direct bilirubin decreased significantly after 3 therapies (P<0.05 or P<0.01). PT, the level of total serum protein decreased significantly and PTa increased significantly after plasma exchange therapy and plasma exchange plus hemoperfusion adsorption therapy (P<0.05 or P<0.01). The side effects were few and mild in all patients. CONCLUSION:Three therapies were effective in the treatment of severe viral hepatitis. Plasma exchange therapy and plasma exchange plus hemoperfusion adsorption therapy are better than hemoperfusion adsorption therapy.

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Section: Discussionmentioning

confidence: 95%

Effects of hemoperfusion adsorption and/or plasma exchange in treatment of severe viral hepatitis: A comparative study

He¹,

Wang²,

Wang³

et al. 2004

WJG

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show abstract

“…Furthermore, this cytokine-induced secondary hepatocellular damage played an important role in the course of hepatitis. Hereby, cytokine removal was good for alleviating liver damage, reducing leukoplania and thrombocyte aggregates, maintaining internal environmental equilibrium, and sequentially slowing down or even reversing the progression of disease and improving prognosis [28][29][30] . Along with the development in molecular biology, research of antagonists for various cytokines has been launched, for example, monoclonal antibody, receptor antibody, soluble antibody.…”

Section: Discussionmentioning

confidence: 99%

Assessment of resin perfusion in hepatic failurein vitroandin vivo

Wang

Wang²,

Luo³

et al. 2004

WJG

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AIM:To observe the adsorbent effect of resin on endotoxin, cytokine, bilirubin in plasma of patients with hepatic failure and to determine the resin perfusion as an artificial liver support system in the treatment of hepatic failure. METHODS:One thousand milliliters of discarded plasma was collected from each of 6 severe hepatitis patients treated with plasma exchange. The plasma was passed through a resin perfusion equipment for 1-2 h via extracorporeal circulation, and then absorbent indicators of transaminase, bilirubin, blood ammonia, endotoxin and cytokines were examined. In the meantime, study of in vivo resin plasma perfusion was performed on 7 severe hepatitis patients to compare the changes of endotoxin and cytokines in blood before and after perfusion. RESULTS:The levels of total bilirubin, endotoxin, interleukin 1β and TNF-α in plasma were significantly decreased after in vitro resin plasma perfusion. The levels of interleukin 1β, TNF-α and endotoxin in blood were also evidently declined after in vivo resin plasma perfusion. Nevertheless, no obvious changes in IL-6, creatinine (Cr) and urea nitrogen (UN), blood ammonia and electrolytes were found both in vitro and in vivo. CONCLUSION:Bilirubin, endotoxin and cytokines in plasma of patients with hepatic failure can be effectively adsorbed by resin in vitro. Most cytokines and endotoxin in plasma can also be effectively removed by resin in vivo. It demonstrates that resin perfusion may have good treatment efficacy on hepatic failure and can be expected to slow down the progression of hepatic failure.Wang YJ, Wang ZW, Luo BW, Liu HL, Wen HW. Assessment of resin perfusion in hepatic failure in vitro and in vivo. World J Gastroenterol 2004; 10(6): 837-840

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“…Because chemical mediators, including inflammatory cytokines, cannot be removed by PE alone in patients with postoperative acute hepatic failure and have failed to achieve any improvement in the survival rate, we are currently eliminating chemical mediators by a method that combines CHDF with PE [12,13], as shown in figure 3. Because sFas, in addition to the inflammatory cytokines, was found to increase in the present study, a balance between inflammatory and anti-inflammatory mediators must be achieved when treating patients with acute hepatic failure.…”

Section: Discussionmentioning

confidence: 99%

“…Plasma exchange (PE) was used to treat all patients, and continuous hemodiafiltration (CHDF) was used in combination [12,13] in 7 of them. Sepsis was present as a complication of acute liver failure at the time of diagnosis in 5 patients.…”

Section: Patientsmentioning

confidence: 99%

Involvement of IL-18 and Soluble Fas in Patients with Postoperative Hepatic Failure

et al. 2003

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We measured the levels of tumor necrosis factor alpha (TNF-α), interleukins (IL)-6 and -18, and soluble Fas (sFas) in 11 patients with postoperative hepatic failure and assessed whether IL-18-mediated apoptosis is involved in the onset of liver dysfunction. The serum TNF-α, IL-18, and sFas levels were significantly higher in patients with sepsis as a complication than in those without sepsis. The TNF-α and IL-18 levels were significantly higher in nonsurvivors than in survivors. Significant correlations were observed between TNF-α and IL-6, between TNF-α and IL-18, and between TNF-α and sFas levels. These results showed that Fas-mediated hepatocyte apoptosis functions as an important mechanism responsible for the onset of postoperative hepatic failure in humans. They especially suggested that IL-18 and TNF-α function both as apoptosis-promoting factors and as apoptosis-inhibiting factors, depending on the conditions to which hepatocytes are subjected.

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Effectiveness of Combining Plasma Exchange and Continuous Hemodiafiltration (Combined Modality Therapy in a Parallel Circuit) in the Treatment of Patients with Acute Hepatic Failure

Cited by 35 publications

References 11 publications

Effects of hemoperfusion adsorption and/or plasma exchange in treatment of severe viral hepatitis: A comparative study

Effects of hemoperfusion adsorption and/or plasma exchange in treatment of severe viral hepatitis: A comparative study

Assessment of resin perfusion in hepatic failurein vitroandin vivo

Involvement of IL-18 and Soluble Fas in Patients with Postoperative Hepatic Failure

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