Haemoperfusion through Activated Charcoal in Dogs with Fulminant Liver Failure

Abstract

The effects of 8-hour haemoperfusion through an activated charcoal column on fulminant hepatic failure were assessed in 10 dogs. The survival in the perfused animals was significantly prolonged and the onset of liver encephalopathy was markedly delayed compared to the controls. Significant decrease in plasma bilirubin and total plasma phenols was found in the perfused group. No other laboratory changes due to haemoperfusion were found. The charcoal column retained its adsorptive capability throughout the experiment as judged from phenol clearance values. In spite of current scepticism regarding its clinical use, further trials with haemoperfusion in acute liver failure seem to be warranted.

The elusive goal of liver support – quest for the Holy Grail

“…Nevertheless, the results halted further development of the charcoal haemoperfusion device, although further controlled trials in experimental animal models of liver failure combined to show statistically significant improvement in survival duration. 16,17 Its use, though, has not been lost completely as columns of absorbent charcoal have become an important component of a number of liver support devices. In other studies at that time, we were able to show, using perfusion of plasma through an ion exchange resin, satisfactory removal of bile acids -200 to 400 µmol in the first hour with corresponding reduction in high serum levels.…”

Review article: liver support systems in acute hepatic failure

“…Subsequently several groups attempted to repeat these observations, but were unsuccessful, encountering problems such as intractable hypotension, charcoal particle emboli, and thrombocytopaenia. 36,37 To improve the biocompatibility of charcoal Weston et al 38 examined the advantages of coated and uncoated charcoal. However, little difference in leucocyte and platelet loss was demonstrated.…”

Clinical Experience with Artificial Liver Support Systems

“…The use of charcoal as an adsorbent of toxic substances from the circulation has been actively studied over the past 25 years. Well designed experiments conducted in animal models of liver failure demonstrated significant improvement in the survival of animals treated with charcoal hemoperfusion compared with controls (29)(30)(31)(32). Initial clinical trials were conducted by Schechter et al (33), Yatzidis and Oreopoulos (34) and Chang (35).…”