Severe hyperbilirubinemia is known to exert multiple toxic effects, but there are very little tools against the bilirubin intoxication. Plasma separation and bilirubin adsorption by an anion-exchange adsorbent column (BR-350) were performed in 13 patients with severe jaundice and multiple organ failure developed either before or after orthotopic liver transplantation. Forty-four sessions were performed and in 30% of them the plasma procedure was combined with hemodialysis treatment.
Three to four liters of plasma were separated by membrane plasma separation, then perfused to a rate of 20–30 ml/min through an anion exchange adsorbent and returned to the venous blood line of the plasma separator.
The bilirubin removal rate for total bilirubin was 24.8 ± 12.9% for conjugated bilirubin and 25.2 ± 14% for the non-conjugated form. The final values of plasma bilirubin were directly related to the initial ones (r = 0.824, P < 0001). The mean adsorption rates on the BR-350 column were 72.6% in the first 30 min and 39% after perfusion of 500 and 1000 ml of plasma respectively. A rebound in the bilirubin levels was present from the very first minutes after the end of the procedure; 24 hours later the rebound recorded in 18 treatment was 34.9 ± 38.7% compared to the end of the treatment.
In patients undergoing four or more repeated sessions of plasma separation and bilirubin adsorption, the level of seric bilirubin decreased from 57 ± 12 to 17 ± 10 mg/dl.
In conclusion, extracorporeal anion exchange plasma perfusion/ bilirubin adsorption is a safe and effective treatment and it should be considered as a supportive therapy for excessive hyperbilirubimenic side effects in cholestatic disorders.