Hemoperfusion

Winchester, James F.

doi:10.1007/978-94-009-1087-4_20

Cited by 11 publications

(6 citation statements)

References 134 publications

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“…The first successful use of the artificial cell in routine clinical applications is hemoperfusion (5–8). After initial clinical trials for poisoning, kidney failure, and liver failure (7), it is now in routine clinical use, especially for the treatment of suicidal or accidental poisoning from medications (8). It is also being used in combination with the hybrid artificial liver in clinical trials.…”

Section: Hemoperfusionmentioning

confidence: 99%

“…The first of these to be developed successfully for routine clinical use is hemoperfusion (4). After initial clinical trials for poisoning, kidney failure, and liver failure (5), it is now in routine clinical use (7,8). Some exciting recent developments include their use for blood substitutes and for the replacement of the metabolic functions of cells and organs (6).…”

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confidence: 99%

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Artificial Cells for Cell and Organ Replacements

Chang¹

2004

Artificial Organs

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The artificial cell is a Canadian invention (Chang, Science, 1964). This principle is being actively investigated for use in cell and organ replacements. The earliest routine clinical use of artificial cells is in the form of coated activated charcoal for hemoperfusion for use in the removal of drugs, and toxins and waste in uremia and liver failure. Encapsulated cells are being studied for the treatment of diabetes, liver failure, and kidney failure, and the use of encapsulated genetically-engineered cells is being investigated for gene therapy. Blood substitutes based on modified hemoglobin are already in Phase III clinical trials in patients, with as much as 20 units being infused into each patient during trauma surgery. Artificial cells containing enzymes are being developed for clinical trial in hereditary enzyme deficiency diseases and other diseases. The artificial cell is also being investigated for drug delivery and for other uses in biotechnology, chemical engineering, and medicine.

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Section: Hemoperfusionmentioning

confidence: 99%

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confidence: 99%

Artificial Cells for Cell and Organ Replacements

Chang¹

2004

Artificial Organs

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“…Therapies such as hemodialysis have a high clearance for small molecular weight toxins, but lack selectivity in chemical removal; everything that can pass through the membrane goes down the drain (8–16). Hemoperfusion, the perfusion of blood directly over coated or uncoated sorbents such as charcoal, has resulted in neurologic improvement of patients with FHF or A‐on‐C hepatic failure but has similarly not resulted in improved outcome of patients with hepatic failure (16–19). The major limitation of hemoperfusion columns is that they saturate with toxins rapidly.…”

Section: History Of Extracorporeal Treatment Of Hepatic Failurementioning

confidence: 99%

Powdered Sorbent Liver Dialysis and Pheresis in Treatment of Hepatic Failure

Ash¹

2001

Therapeutic Apheresis

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The Liver Dialysis Unit (the Unit) is a liver‐assist device that employs hemodiabsorption (dialysis of blood against powdered sorbents) to selectively remove numerous small molecular weight toxins of hepatic failure. The Unit has been cleared by the Food and Drug Administration and is indicated and marketed for treatment of acute hepatic encephalopathy (AHE) due to decompensation of chronic liver disease (A‐on‐C) or fulminant hepatic failure (FHF). Controlled, prospective, and randomized studies of liver dialysis were conducted at several centers, enrolling 56 patients with AHE, grades II–IV with or without renal and respiratory insufficiency or failure. Liver dialysis treatments were for 6 h daily, 1–5 days with similar observation periods for control patients. Physiologic status, neurologic status, and outcome (recovery of hepatic function, improvement for transplant, or death) were measured, and results were compared for treated patients versus controls for patients with A‐on‐C and patients with FHF. Liver dialysis resulted in physiologic and neurologic improvement of patients with AHE, regardless of etiology. Liver dialysis significantly improved the incidence of positive outcomes (recovery of hepatic function or improvement for transplant) of A‐on‐C patients versus controls (71.5% treated, 35.7% control, p = 0.036), but had an insignificant improvement in the outcome of patients with FHF as compared with the control group. Among the overall 31 treated patients, 51.6% survived. Outcome was not negatively affected by the presence of kidney failure or respiratory failure. The plasmafilter unit (PF‐Unit) combines hemodiabsorption with push‐pull sorbent‐based pheresis (the PF add‐on module, with powdered sorbent surrounding plasmafilters). At blood flow rates of 200 ml/min, the system clears creatinine and aromatic amino acids at 120–160 ml/min, unconjugated bilirubin at 20–40 ml/min, and cytokines at 15–25 ml/min. The PF‐Unit has been tested in a few patients with hepatic failure with Grades III and IV encephalopathy, and respiratory, and kidney insufficiency. Treatment appeared to be safe, and there were no significant hematologic changes. Physiologic changes included improved blood pressure, and encephalopathy, and stable urine output. Chemical changes included a decrease in the plasma levels of bilirubin, aromatic amino acids, ammonium, creatinine, and IL‐1β. The PF add‐on module adds the capability to the Unit to remove bilirubin and other strongly protein‐bound toxins from treated patients and may be of clinical benefit in the management of patients with the most severe hepatic failure and encephalopathy, including patients with FHF or concomitant sepsis.

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“…This is because of particulate embolism and blood cells removal. Sorbents like activated charcoal inside artificial cells no longer caused particulate embolism and blood cells removal 4,8,9,30,31. Artificial cells with polymer membrane containing adsorbents have been used in hemoperfusion for the routine treatment of patients for many years 30,31 .…”

Section: Other Areas Of Research On Artificial Cellsmentioning

confidence: 99%

Artificial Cells and Bioencapsulation in Bioartificial Organs^a

Chang

1997

Annals of the New York Academy of Sciences

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Hemoperfusion

Cited by 11 publications

References 134 publications

Artificial Cells for Cell and Organ Replacements

Artificial Cells for Cell and Organ Replacements

Powdered Sorbent Liver Dialysis and Pheresis in Treatment of Hepatic Failure

Artificial Cells and Bioencapsulation in Bioartificial Organs^a

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Hemoperfusion

Cited by 11 publications

References 134 publications

Artificial Cells for Cell and Organ Replacements

Artificial Cells for Cell and Organ Replacements

Powdered Sorbent Liver Dialysis and Pheresis in Treatment of Hepatic Failure

Artificial Cells and Bioencapsulation in Bioartificial Organsa

Contact Info

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Artificial Cells and Bioencapsulation in Bioartificial Organs^a