Skip to main content
PMC home page
Gut logoLink to Gut
. 1978 Sep;19(9):787–793. doi: 10.1136/gut.19.9.787

Treatment of encephalopathy during fulminant hepatic failure by haemodialysis with high permeability membrane.

J Denis, P Opolon, V Nusinovici, A Granger, F Darnis
PMCID: PMC1412181  PMID: 710967

Abstract

Forty-one patients with fulminant hepatic failure and coma underwent 180 periods of haemodialysis with polyacrylonitrile membrane (AN 69 HD). Hepatic failure was due to viral hepatitis in 40 and drugs in one. Total recovery of consciousness occurred in 17 patients (43.6%), and partial in seven (17.9%)--that is, an overall figure of 61.5%. Regain of consciousness was not related to liver regeneration as assessed by levels of factor V and hepatocyte volume fraction. At the time of the first haemodialysis, neurological status was significantly impaired in the patients who could not be aroused. Mean duration of coma grade IV averaged 6.1 +/- 4.3 days and mean duration of illness until death or decerebration 8.6 +/- 8.3 days. Of the 17 patients who totally regained consciousness, nine recovered and eight died (three from intercurrent complications and five with no liver regeneration).

Full text

PDF
787

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bloch P., Delorme M. L., Rapin J. R., Granger A., Boschat M., Opolon P. Reversible modifications of neurotransmitters of the brain in experimental acute hepatic coma. Surg Gynecol Obstet. 1978 Apr;146(4):551–558. [PubMed] [Google Scholar]
  2. Farivar M., Wands J. R., Isselbacher K. J., Bucher N. L. Effect of insulin and glucagon on fulminant murine hepatitis. N Engl J Med. 1976 Dec 30;295(27):1517–1519. doi: 10.1056/NEJM197612302952706. [DOI] [PubMed] [Google Scholar]
  3. Fischer J. E., Baldessarini R. J. Pathogenesis and therapy of hepatic coma. Prog Liver Dis. 1976;5:363–397. [PubMed] [Google Scholar]
  4. Fischer J. E., Funovics J. M., Aguirre A., James J. H., Keane J. M., Wesdorp R. I., Yoshimura N., Westman T. The role of plasma amino acids in hepatic encephalopathy. Surgery. 1975 Sep;78(3):276–290. [PubMed] [Google Scholar]
  5. Gazzard B. G., Portmann B., Murray-Lyon I. M., Williams R. Causes of death in fulminant hepatic failure and relationship to quantitative histological assessment of parenchymal damage. Q J Med. 1975 Oct;44(176):615–626. [PubMed] [Google Scholar]
  6. Gazzard B. G., Weston M. J., Murray-Lyon I. M., Flax H., Record C. O., Williams R., Portmann B., Langley P. G., Dunlop E. H., Mellon P. J. Charcoal haemoperfusion in the treatment of fulminant hepatic failure. Lancet. 1974 Jun 29;1(7870):1301–1307. doi: 10.1016/s0140-6736(74)90678-3. [DOI] [PubMed] [Google Scholar]
  7. Hume D. M., Gayle W. E., Jr, Williams G. M. Cross circulation of patients in hepatic coma with baboon partners having human blood. Surg Gynecol Obstet. 1969 Mar;128(3):495–517. [PubMed] [Google Scholar]
  8. Klebanoff G., Hollander D., Cosimi A. B., Stanford W., Kemmerer W. T. Asanguineous hypothermic total body perfusion (TBW) in the treatment of stage IV hepatic coma. J Surg Res. 1972 Jan;12(1):1–7. doi: 10.1016/0022-4804(72)90136-9. [DOI] [PubMed] [Google Scholar]
  9. Muller J. M., Motin J., Guignier M., Paliard P., Debru J. L. Notre expérience de la circulation croisée comme méthode d'assistance hépatique dans les nsuffisances hépatiques graves aiguës. Ann Med Interne (Paris) 1971 May;122(5):581–587. [PubMed] [Google Scholar]
  10. Nusinovici V., Crubille C., Opolon P., Touboul J. P., Darnis F., Caroli J. Hépatites fulminantes avec coma. Revue de 137 cas. I. Complications. Gastroenterol Clin Biol. 1977;1(11):861–873. [PubMed] [Google Scholar]
  11. Nusinovici V., Crubille C., Opolon P., Touboul J. P., Darnis F., Caroli J. Hépatites fulminantes avec coma. Revue de 137 cas. II. Evolution & pronostic. Gastroenterol Clin Biol. 1977;1(11):875–886. [PubMed] [Google Scholar]
  12. Opolon P., Hecht Y., Theodoropoulos G., Hadchouel P., Grynblat A., Caroli J. Ictères graves par nécrose hépatique aiguë. Rev Med Chir Mal Foie. 1969;44(6):251–290. [PubMed] [Google Scholar]
  13. Opolon P., Lavallard M. C., Crubille C., Gateau P., Nusinovici V., Granger A., Darnis F., Caroli J. Encéphalopathie au cours de l'atrophie hépatique aiguë. Effet de l'épuration des moyennes molécules. Résultats préliminaires. Nouv Presse Med. 1975 Dec 6;4(42):2987–2991. [PubMed] [Google Scholar]
  14. Opolon P., Lavallard M. C., Huguet C., Bidallier M., Granger A., Gallot D., Bloch P. Hemodialysis versus cross hemodialysis in experimental hepatic coma. Surg Gynecol Obstet. 1976 Jun;142(6):845–853. [PubMed] [Google Scholar]
  15. Opolon P., Rapin J. R., Huguet C., Granger A., Delorme M. L., Boschat M., Sausse A. Hepatic failure coma (HFC) treated by polyacrylonitrile membrane (PAN) hemodialysis (HD). Trans Am Soc Artif Intern Organs. 1976;22:701–710. [PubMed] [Google Scholar]
  16. Record C. O., Buxton B., Chase R. A., Curzon G., Murray-Lyon I. M., Williams R. Plasma and brain amino acids in fulminant hepatic failure and their relationship to hepatic encephalopathy. Eur J Clin Invest. 1976 Sep 10;6(5):387–394. doi: 10.1111/j.1365-2362.1976.tb00533.x. [DOI] [PubMed] [Google Scholar]
  17. Rosen H. M., Yoshimura N., Hodgman J. M., Fischer J. E. Plasma amino acid patterns in hepatic encephalopathy of differing etiology. Gastroenterology. 1977 Mar;72(3):483–487. [PubMed] [Google Scholar]
  18. Rueff B., Benhamou J. P. Acute hepatic necrosis and fulminant hepatic failure. Gut. 1973 Oct;14(10):805–815. doi: 10.1136/gut.14.10.805. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Rueff B., Roche-Sicot J., Sicot C. Traitement de l'insuffisance hépato-cellulaire aigue grave par circulation croisée. Méthodes et résultats. Ann Anesthesiol Fr. 1974;15(SPEC):249–254. [PubMed] [Google Scholar]
  20. Saunders S. J., Terblanche J., Bosman S. C., Harrison G. G., Walls R., Hickman R., Biebuyck J., Dent D., Pearce S., Barnard C. N. Acute hepatic coma treated by cross-circulation with a baboon and by repeated exchange transfusions. Lancet. 1968 Sep 14;2(7568):585–588. doi: 10.1016/s0140-6736(68)90692-2. [DOI] [PubMed] [Google Scholar]
  21. Scotto J., Opolon P., Etévé J., Vergoz D., Thomas M., Caroli J. Liver biopsy and prognosis in acute liver failure. Gut. 1973 Dec;14(12):927–933. doi: 10.1136/gut.14.12.927. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sicot C., Fréjaville J. P., Roche J., Rueff B., Benhamou J. P., Fauvert R. Six cas d'hépatite grave traitée par circulation croisée interhumaine. Ann Med Interne (Paris) 1971 Mar;122(3):381–387. [PubMed] [Google Scholar]
  23. Silk D. B., Trewby P. N., Chase R. A., Mellon P. J., Hanid M. A., Davies M., Langley P. G., Wheeler P. G., Williams R. Treatment of fulminant hepatic failure by polyacrylonitrile-membrane haemodialysis. Lancet. 1977 Jul 2;2(8027):1–3. doi: 10.1016/s0140-6736(77)90001-0. [DOI] [PubMed] [Google Scholar]
  24. Silk D. B., Williams R. Experiences in the treatment of fulminant hepatic failure by conservative therapy, charcoal haemoperfusion, and polyacrylonitrile haemodialysis. Int J Artif Organs. 1978 Jan;1(1):29–33. [PubMed] [Google Scholar]
  25. Ware A. J., D'Agostino A. N., Combes B. Cerebral edema: a major complication of massive hepatic necrosis. Gastroenterology. 1971 Dec;61(6):877–884. [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES