Skip to main content
SpringerLink
Log in

Single-pass albumin dialysis and hemoadsorption for bilirubin and bile acids removal for a child with hyperbilirubinemia after ventricular assist device implantation

  • Case Report
  • Artificial Heart (Clinical)
  • Published:
Journal of Artificial Organs Aims and scope Submit manuscript

Abstract

We report the successful management of hyperbilirubinemia using two different modalities of extracorporeal bilirubin removal therapy for a pediatric patient. A 13-year-old boy with dilated cardiomyopathy requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) developed acute kidney injury and was dependent on continuous renal replacement therapy. He developed hyperbilirubinemia with a peak total bilirubin level of 786 μmol/L after implantation of biventricular assist device (BiVAD). Extracorporeal bilirubin and bile acids removal using single-pass albumin dialysis (SPAD) with 4% albumin as dialysate brought down the bilirubin level to 672 μmol/L after 21 h of therapy. Subsequently, he was started on two sessions of hemoadsorption using the Cytosorb® column which further lowered the total bilirubin level to 306 μmol/ in 24 h and 173 μmol/ after the treatment. No complication was encountered. Our case illustrated that both SPAD and hemoadsorption can effectively and safely reduce the serum bilirubin and bile acid levels in pediatric patients with BiVAD implantation. The ease of set-up, faster rate of bilirubin decline and capability of cytokine removal make hemoadsorption a favorable alternative to albumin dialysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Majumder K, Spratt JR, Holley CT, Roy SS, Cogswell RJ, Liao K, John R. Impact of postoperative liver dysfunction on survival after left ventricular assist device implantation. Ann Thorac Surg. 2017;104:1556–62.

    Article  Google Scholar 

  2. Yang JA, Kato TS, Shulman BP, Takayama H, Farr M, Jorde UP, Mancini DM, Naka Y, Schulze PC. Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: Use of the Model of End-stage Liver Disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system. J Heart Lung Transplant. 2012;31:601–10.

    Article  Google Scholar 

  3. Wadia Y, Etheridge W, Smart F, Wood RP, Frazier OH. Pathophysiology of hepatic dysfunction and intrahepatic cholestasis in heart failure and after left ventricular assist device support. J Heart Lung Transplant. 2005;24:361–70.

    Article  Google Scholar 

  4. Hui WF, Hon KL, Leung AK, Leung KKY, Ku SW, Cheng FW. Continuous renal replacement therapy (CRRT) for nonrenal indications among critically ill children with malignancy. Case Reports Pediatrics. 2021. https://doi.org/10.1155/2021/6660466.

    Article  Google Scholar 

  5. Piwowarczyk P, Kutnik P, Potręć-Studzińska B, Sysiak-Sławecka J, Rypulak E, Borys M, Czczuwar M. Hemoadsorption in isolated conjugated hyperbilirubinemia after extracorporeal membrane oxygenation support. Cholestasis of sepsis: A case report and review of the literature on differential causes of jaundice in ICU patient. Int J Artif Organs. 2019;42:263–8.

    Article  CAS  Google Scholar 

  6. Rainer PP, Primessnig U, Harenkamp S, Doleschal B, Wallner M, Fauler G, Stojakovic T, Wachter R, Yates A, Groschner K, Trauner M, Pieske BM, von Lewinski D. Bile acids induce arrhythmias in human atrial myocardium–implications for altered serum bile acid composition in patients with atrial fibrillation. Heart. 2013;99:1685–92.

    Article  CAS  Google Scholar 

  7. Horvatits T, Drolz A, Rutter K, Roedl K, Langouche L, Van den Berghe G, Fauler G, Meyer B, Hülsmann M, Heinz G, Trauner M, Fuhrmann V. Circulating bile acids predict outcome in critically ill patients. Ann Intensive Care. 2017:48.

    Article  Google Scholar 

  8. Alshamsi F, Alshammari K, Belley-Cote E, Dionne J, Albrahim T, Albudoor B, Ismail M, Al-Judaibi B, Baw B, Subramanian RM, Steadman R, Galusca D, Huang DT, Nanchal R, Al Quraini M, Yuan Y, GUIDE Group. Alhazzani W Extracorporeal liver support in patients with liver failure: a systematic review and meta-analysis of randomized trials. Intensive Care Med. 2020;46:1–16.

    Article  Google Scholar 

  9. Ankawi G, Xie Y, Yang B, Xie Y, Xie P, Ronco C. What have we learned about the use of cytosorb adsorption columns? Blood Purif. 2019;48:196–202.

    Article  CAS  Google Scholar 

  10. Gemelli C, Cuoghi A, Magnani S, Atti M, Ricci D, Siniscalchi A, Mancini E, Faenza S. Removal of bilirubin with a new adsorbent system: In vitro kinetics. Blood Purif. 2019;47:10–5.

    Article  CAS  Google Scholar 

  11. Dominik A, Stange J. Similarities, differences, and potential synergies in the mechanism of action of albumin dialysis using the MARS albumin dialysis device and the CytoSorb hemoperfusion device in the treatment of liver failure. Blood Purif. 2021;50:119–28.

    Article  CAS  Google Scholar 

  12. Schmuck RB, Nawrot GH, Fikatas P, Reutzel-Selke A, Pratschke J, Sauer IM. Single pass albumin dialysis - A dose-finding study to define optimal albumin concentration and dialysate flow. Artif Organs. 2017;41:153–61.

    Article  CAS  Google Scholar 

  13. Scharf C, Liebchen U, Paal M, Becker-Pennrich A, Irlbeck M, Zoller M, Schroeder I. Successful elimination of bilirubin in critically ill patients with acute liver dysfunction using a cytokine adsorber and albumin dialysis: a pilot study. Sci Rep. 2021;11:10190.

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Kin Shing Lun

    Present address: Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Doctor’s Office, 9/F, Tower B, 1 Shing Cheong Road, Kowloon Bay, Kowloon, Hong Kong SAR

Authors and Affiliations

  1. Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Doctor’s Office, 9/F, Tower B, 1 Shing Cheong Road, Kowloon Bay, Kowloon, Hong Kong SAR

    Wun Fung Hui & Kam Lun Hon

Authors
  1. Wun Fung Hui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kin Shing Lun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kam Lun Hon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Wun Fung Hui or Kam Lun Hon.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hui, W.F., Lun, K.S. & Hon, K.L. Single-pass albumin dialysis and hemoadsorption for bilirubin and bile acids removal for a child with hyperbilirubinemia after ventricular assist device implantation. J Artif Organs 25, 270–273 (2022). https://doi.org/10.1007/s10047-022-01309-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10047-022-01309-4

Keywords

Search

Navigation