Exchange Transfusion in Hepatic Coma: Report of a Case

Lee, Charles; Tink, Arnold

doi:10.5694/j.1326-5377.1958.tb85989.x

Cited by 74 publications

(13 citation statements)

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“…The blood exchange approach was introduced by Lee and Tink in 1958 5. A 13‐year old boy in hepatic coma of unknown etiology underwent two cycles of fresh blood exchange transfusion; elevated serum bilirubin levels fell to normal and he regained full consciousness.…”

Section: Non‐biological Liver Support Systemsmentioning

confidence: 99%

Artificial liver: Review and Cedars-Sinai experience

Kamohara

Rózga

Demetriou

1998

Journal of Hepato-Biliary-Pancreatic Surgery

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During the past decade, whole organ transplantation has become the only clinically effective method of treating fulminant hepatic failure and chronic liver failure due to specific genetic, hepatocellular, and anatomic defects of liver function. However, wider application of liver transplantation is restricted by shortage of organ donors, high cost, relatively high morbidity, and need for life-long immunosuppression. As a result, investigators have attempted to develop alternative methods to treat liver insufficiency. These ranged from use of plasma exchange to utilization of detoxification columns and extracorporeal devices loaded with various liver tissue preparations. Recently, advances in hepatocyte isolation and culture techniques, improved understanding of hepatocyte-matrix interactions, availability of new biomaterials, improved hollow-fiber technology, and better understanding of flow and mass transport across semipermeable membranes have resulted in the development of a new generation of liver assist devices. Some of these devices, including the one developed by the authors, are currently being tested in the clinical setting. In this paper, the past experience with liver support systems is reviewed, the present status of the field is critically examined, and the results of a phase I clinical trial with the bioartificial liver, utilizing primary porcine hepatocytes, are summarized.

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Section: Non‐biological Liver Support Systemsmentioning

confidence: 99%

Artificial liver: Review and Cedars-Sinai experience

Kamohara

Rózga

Demetriou

1998

Journal of Hepato-Biliary-Pancreatic Surgery

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“…The concept of blood purification has been used to support patients with liver failure since first performed in 1957 ( 1) because in the blood of those patients, toxic substances are supposed to exist. However, controlled studies with blood exchange performed thereafter in the 1960s and early 1970s were found to be ineffective on the mortality rate for acute liver failure ( 2, 3).…”

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confidence: 99%

Total Blood Exchange Suppresses the Early Stage of Liver Regeneration Following Partial Hepatectomy in Rats

et al. 1998

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Despite its obscure and short effect, plasma exchange (PE) remains a mainstay in the treatment of liver disease. However, the question still remains as to whether or not PE suppresses the regeneration of the liver because PE deprives patients of hepatotrophic factors. The effect of PE, which could be a total blood exchange (TBE) in a syngeneic setting, on liver regeneration following a 68% partial hepatectomy (PH) was investigated in rats. In Group 1, 20 ml of blood from normal rats was infused while native blood was removed at 6 and 12 h after PH. In Group 2, 20 ml of blood obtained from PH rats at the same time points was infused. The regeneration rate, labeling index of proliferating cell nuclear antigen (PCNA), and plasma hepatocyte growth factor (HGF) level were determined, and standard liver function tests performed at 24, 48, and 72 h. Although all liver function tests improved in Group 1 at 24 and 48 h, the regeneration rate was significantly impaired. Similarly, the PCNA labeling index was significantly lower in Group 1 than that in Group 2. The plasma HGF level was significantly reduced in Group 1 (6 h blood out versus blood in: 1.1+/-0.5 vs. 0.1+/-0.1 ng/ml, p < 0.05). TBE with normal blood following PH suppressed the early stage of liver regeneration, in part, because of the reduction of HGF even though the blood was purified.

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“…Exchange transfusion is theoretically assumed to improve this condition by removing toxic substances from the blood and adding essential substances synthesized by the liver. Although its benefit has been shown in animal experiments (2)(3)(4) and also suggested by clinical experience (5)(6)(7)(8)(9), the results of a controlled trial in fulminant hepatitis were negative (10).…”

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confidence: 99%

Exchange Blood Transfusion for Acute Hepatic Failure: Its Limited Availability Depending on the Type of Injury in Rats

et al. 1988

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The efficacy of exchange blood transfusion for acute hepatic failure was evaluated using rats. Rats receiving a dose of carbon tetrachloride died later than 24 h after dosing. When their blood was replaced with blood from normal rats at 24 h, survival time was prolonged, and hepatic protein synthesis was enhanced at 36 h with improved prothrombin time (PT). Those rats surviving 120 h showed better histological grade of recovery from injury after treatment. In contrast, dimethylnitrosamine (DMN)-intoxicated rats showed no such improvement in survival time or PT. In rats given a nonfatal dose of carbon tetrachloride, serum glutamic-pyruvic transaminase values were five times higher than those in rats given DMN despite similar maximal PT. The benefit of exchange transfusion for acute hepatic failure may differ depending on the mechanism of development in rats. Enhanced hepatic protein synthesis may contribute to its effect.

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Exchange Transfusion in Hepatic Coma: Report of a Case

Cited by 74 publications

References 0 publications

Artificial liver: Review and Cedars-Sinai experience

Artificial liver: Review and Cedars-Sinai experience

Total Blood Exchange Suppresses the Early Stage of Liver Regeneration Following Partial Hepatectomy in Rats

Exchange Blood Transfusion for Acute Hepatic Failure: Its Limited Availability Depending on the Type of Injury in Rats

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