Hepatic Assist System Using Bead-Type Charcoal
Our hepatic assist system consists of a combination of hemo-perfusion (200Gm of bead-type charcoal coated with 0.5μm collodion in a column) and hemodialysis against 35 liters of acetate-free recirculating dialysate. Totally, 55 perfusions have been performed in 15 patients with acute liver failure (viral hepatitis 13, and halothan-associated 2) and 3 patients with post-hepatic cirrhosis (1 with porto-caval shunt). The most frequently treated patient underwent 9 perfusions, each for 3 hours. Of the above 15 patients, 6 patients partially recovered consciousness. The EEG findings after hemoperfusion improved in 3 patients, remained unchanged in 3 and were impaired in 3. Three patients with acute liver failure has survived. Complications in the other 12 patients were; G.I. bleeding 5, renal failure 2, respiratory failure 3, and cerebral edema 4. The total plasma amino acids had been 245.1mg/100ml (normal control 47.1mg/100ml) on an average, and they decreased by 26.2% after hemoperfusion. The total amino acids in cerebro-spinal fluid (CSF) was 81.9mg/ml (normal control 7.8mg/100ml) on an average, in which glutamine, methionine, tyrosin and phenylalanine were significantly high. The total CSF amino acids soon after perfusion decreased by 4.1%. And, in patients with improved EEG grades, the total CSF amino acids were further lowered by 18.2%in 5 hours.
KeywordsAcute Liver Failure Total Amino Acid Plasma Amino Acid Consciousness Level Hepatic Coma
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