Abstract
A new artificial liver support system (ALSS) consisting of plasma exchange (PE) in combination with hemodiafiltration (HDF) using high-performance membranes of polymethyl metacrylate (PMMA) and cellulose triacetate (CTA) was developed to efficiently remove middle molecules from plasma and treat fulminant hepatic failure (FHF) complicated, by the onset of hepatic coma. Twenty-seven patients with FHF due to viral hepatitis, two with type A (HA), nine with type B (HB), and 16 with type non-A, non-B (NANB) underwent therapy with this new ALSS over the last five years. Three patients, with an exacerbation of chronic HB and 15/16 with type NANB hepatitis were treated with interferon (IFN) also. Of these, 25 patients (92.6%), regained consciousness and 15 (55.6%) [1/2 (50%) with type A, 6/9 (66.7%) with type B and 8/16 (50%) with type NANB hepatitis] survived Including four patients who survived with intensive, care and plasma exchange alone, 19/31 (61.3%) patients survived. Because of its biocompatibility, both survivors and nonsurvivors could be sustained with the ALSS without complications for long periods (19.3 days for the survivors and 32.4 days for nonsurvivors). With this ALSS the ability to sustain life for such prolonged periods allows hepatic regeneration to occur and result in patient survival. It is anticipated that this new ALSS will not only be of value in cases of fulminant hepatic failure but that it may also play a role in sustaining life for those, awaiting liver transplantation.
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Trey C, Burns DG, Saunders SJ: Treatment of hepatic coma by exchange blood transfusion. N Engl J Med 274:473–481, 1966
Lepore MJ, Martel AJ: Plasmapheresis in hepatic coma. Lancet 2:771–772, 1967
Gazzard BG, Weston MJ, Murray-Lyon, IM, Frax H, Record CO, Portmann B, Langley PG, Dunlop EH, Mellon PJ, Ward MB, Williams R: Charcoal hemoperfusion in the treatment of fulminant hepatic failure. Lancet 1:1301–1307, 1974
Yamazaki Z, Fujimori Y, Sanjo K, Kojima Y, Sugiura M, Wada J, Inoue N, Sakai T, Oda T, Kominami N, Fujisaki U, Kataoka K: New artificial liver support system (Plasma perfusion detoxification) for hepatic coma. Artif Organs 2:(Suppl) 273–276, 1978
Denis J, Opolon, P, Nusinovici V, Granger A, Darnis F: Treatment of encephalopathy during fulminant hepatic failure by hemodialysis with high permeability membrane. Gut 19:787–793, 1978
Redeker AG, Yamahiro HS: Controlled trial of exchangetransfusion therapy in fulminant hepatitis. Lancet 1:3–6, 1973
O'Grady JG, Gimson AES, O'Brien CJ, Pucknell A, Hughes RD, Williams R: Controlled trials of charcoal hemoperfusion and prognostic factors in fulminant hepatic failure. Gastroenterology 94:1186–1192, 1988
Silk DBA, Hanid MA, Treby PN, Davies M, Chase RA, Langley PG, Mellon PJ, Wheeler PG, Williams R: Treatment of fulminant hepatic, failure by polyacrilonitrile membrane hemodialysis. Lancet 2:1–3, 1977
Starzl TE, Demetris AJ, Theil DHV: Liver transplantation. N Engl J Med 321:1014–1022, 1989
Shafer DS, Shaw BW: Fulminant hepatic failure and orthotopic liver transplantation. Sem Liver Dis, 9:189–194, 1989
Peleman RBP, Gavaler JS, Thiel DHV, Esquivel, C, Gordon R, Iwatsuki S, Starzl TE: Orthotopic liver transplantation for acute and subacute hepatic failure in adults. Hepatology 7:484–489, 1987
Calledan M, Gislon M, Doglia M, Fassatic LR, Ferla LR, Gridelli B, Rossi G, Galmarini D: Liver transplantation in patients with B viral hepatitis and delta infection. Transplant Proc 5:4073–4076, 1987
Yoshiba M, Inoue N, Sanjo T, Yamazaki Z, Okada Y, Oda T, Wada T: Plasmapheresis in acute liver failure.In Plasmapheresis Therapeutic Applications and New Techniques, Y Nose, PS Malchesky, JW Smith, RS Krakauer, (eds). New York, Raven Press, 1983, pp 399–406
Opolon P: Significance of middle molecules in the pathogenesis of hepatic encephalopathy.In Advances in Hepatic Encephalopathy and Urea Cycle Diseases, G Kleinberger, P Ferenci, P Riederer, H Thaler, (eds). Basel, Karger, 1984, pp 301–309
Yoshiba M, Yamada H, Yoshikawa Y, Fujiwara K, Toda G, Oka H, Sanjo T, Yamazaki Z, Idezuki Y, Inoue N, Sakai T, Kunitoma T: Hemodiafiltration treatment of deep hepatic coma by protein passing membrane: Case report. Artif Organs 10:417–421, 1986
Gimson AES, O'Grady J, Ede RJ, Portmann B, Williams R: Late onset hepatic failure: Clinical, serological and histological features. Hepatology 6:288–294, 1986
Okamoto H, Okada S, Sugiyama Y, Tanaka T, Sugai Y, Akahane Y, Machida A, Mishiro S, Yoshizawa H, Miyakawa Y, Mayumi M: Detection of hepatitis C virus RNA by a two-stage polymerase chain reaction with two pairs of primers deduced from the 5′-noncoding region. Japan J Exp Med 60:215–222, 1990
Okamoto H, Munekata E, Tsuda F, Takahashi K, Yotsumoto S, Tanaka T, Tachibana K, Akahane Y, Sugai Y, Miyakawa Y, Mayumi M: Enzyme-linked immunosorbent assay for antibodies against the capsid protein of hepatitis C virus with a synthetic oligopeptide. Jpn J Exp Med 60:223–233, 1990
Okamoto H, Tsuda F, Machida A, Munekata E, Akahane Y, Sugai Y, Mashiko K, Mitsui T, Tanaka T, Miyakawa Y, Mayumi M: Antibodies against synthetic oligopeptides deduced from the putative core gene for the diagnosis of hepatitis C virus infection. Hepatology 15:180–186, 1992
Kinugasa E, Akizawa T, Kitaoka T, Koshikawa S: Evaluation of beta2-microglobulin removal with high-performance hemodiafiltration. Artif Organs 12:10–15, 1988
Yoshikawa Y, Yamada H, Yoshiba M, Fujiwara K, Toda G, Oka H, Ichikawa K, Ichikawa H: Biocompatibility of polymethyl metacrylate (PMMA) membrane-Effect on blood coagulation and the fibrinolysis system.In Therapeutic Plasmapheresis (V), T Oda (ed). Shattauer Verlag, 1986, pp. 225–230
Yoshiba M, Sanjo T, Tamazaki Z, Inoue N, Sakai T, Okada Y, Yamada H, Fujiwara K, Oka H, Oda T, Wada T: Aggravation of coagulation abnormality by charcoal plasma perfusion in dogs with experimental acute liver failure. Acta Hepatol Jpn 24:426–431, 1983
Gimson AES, Braude S, Mellon PJ, Canalese, J, Williams R: Earlier charcoal haemoperfusion in fulminant hepatic failure. Lancet 2:681–683, 1982
O'Grady JG, Alexander GJM, Mayllar KM, Williams R: Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 97:439–445, 1989
Brechot C, Bernuau J, Thiers V, Dubois F, Goudeau A, Rueff B, Tiollais P, Benhamou, J-P: Multiplication of hepatitis B virus in fulminant hepatitis B. Br Med J 288:270–271, 1984
Cock KM, Govindarajan S, Valinluck B, Redeker AG: Hepatitis B virus DNA in fulminant hepatitis B. Ann Intern Med 105:546–547, 1986
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Yoshiba, M., Sekiyama, K., Iwamura, Y. et al. Development of reliable artificial liver support (ALS)-plasma exchange in combination with hemodiafiltration using high-performance membranes. Digest Dis Sci 38, 469–476 (1993). https://doi.org/10.1007/BF01316501
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DOI: https://doi.org/10.1007/BF01316501