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. 1993;38(3):469–476. doi: 10.1007/BF01316501

Development of reliable artificial liver support (ALS)-plasma exchange in combination with hemodiafiltration using high-performance membranes

Makoto Yoshiba 1,✉, Kazuhiko Sekiyama 1, Yukari Iwamura 1, Famio Sugata 1
PMCID: PMC7101817  PMID: 8444078

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.

Key words: artificial liver support system, plasma exchange, hemodiafiltration

References

  • 1.Trey C, Burns DG, Saunders SJ. Treatment of hepatic coma by exchange blood transfusion. N Engl J Med. 1966;274:473–481. doi: 10.1056/NEJM196603032740901. [DOI] [PubMed] [Google Scholar]
  • 2.Lepore MJ, Martel AJ. Plasmapheresis in hepatic coma. Lancet. 1967;2:771–772. [Google Scholar]
  • 3.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. 1974;1:1301–1307. doi: 10.1016/s0140-6736(74)90678-3. [DOI] [PubMed] [Google Scholar]
  • 4.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. 1978;2(Suppl):273–276. doi: 10.1046/j.1526-0968.2000.00234.x. [DOI] [PubMed] [Google Scholar]
  • 5.Denis J, Opolon P, Nusinovici V, Granger A, Darnis F. Treatment of encephalopathy during fulminant hepatic failure by hemodialysis with high permeability membrane. Gut. 1978;19:787–793. doi: 10.1136/gut.19.9.787. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Redeker AG, Yamahiro HS. Controlled trial of exchangetransfusion therapy in fulminant hepatitis. Lancet. 1973;1:3–6. doi: 10.1016/s0140-6736(73)91220-8. [DOI] [PubMed] [Google Scholar]
  • 7.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. 1988;94:1186–1192. doi: 10.1016/0016-5085(88)90011-x. [DOI] [PubMed] [Google Scholar]
  • 8.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. 1977;2:1–3. doi: 10.1016/s0140-6736(77)90001-0. [DOI] [PubMed] [Google Scholar]
  • 9.Starzl TE, Demetris AJ, Theil DHV. Liver transplantation. N Engl J Med. 1989;321:1014–1022. doi: 10.1056/NEJM198910123211505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Shafer DS, Shaw BW. Fulminant hepatic failure and orthotopic liver transplantation. Sem Liver Dis. 1989;9:189–194. doi: 10.1055/s-2008-1040512. [DOI] [PubMed] [Google Scholar]
  • 11.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. 1987;7:484–489. doi: 10.1002/hep.1840070312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.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. 1987;5:4073–4076. [PubMed] [Google Scholar]
  • 13.Yoshiba M, Inoue N, Sanjo T, Yamazaki Z, Okada Y, Oda T, Wada T. Plasmapheresis in acute liver failure. In: Nose Y, Malchesky PS, Smith JW, Krakauer RS, editors. Plasmapheresis Therapeutic Applications and New Techniques. New York: Raven Press; 1983. pp. 399–406. [Google Scholar]
  • 14.Opolon P. Significance of middle molecules in the pathogenesis of hepatic encephalopathy. In: Kleinberger G, Ferenci P, Riederer P, Thaler H, editors. Advances in Hepatic Encephalopathy and Urea Cycle Diseases. Basel: Karger; 1984. pp. 301–309. [Google Scholar]
  • 15.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. 1986;10:417–421. doi: 10.1111/j.1525-1594.1986.tb02590.x. [DOI] [PubMed] [Google Scholar]
  • 16.Gimson AES, O'Grady J, Ede RJ, Portmann B, Williams R. Late onset hepatic failure: Clinical, serological and histological features. Hepatology. 1986;6:288–294. doi: 10.1002/hep.1840060222. [DOI] [PubMed] [Google Scholar]
  • 17.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. 1990;60:215–222. [PubMed] [Google Scholar]
  • 18.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. 1990;60:223–233. [PubMed] [Google Scholar]
  • 19.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. 1992;15:180–186. doi: 10.1002/hep.1840150203. [DOI] [PubMed] [Google Scholar]
  • 20.Kinugasa E, Akizawa T, Kitaoka T, Koshikawa S. Evaluation of beta2-microglobulin removal with high-performance hemodiafiltration. Artif Organs. 1988;12:10–15. doi: 10.1111/j.1525-1594.1988.tb01517.x. [DOI] [PubMed] [Google Scholar]
  • 21.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
  • 22.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. 1983;24:426–431. [Google Scholar]
  • 23.Gimson AES, Braude S, Mellon PJ, Canalese J, Williams R. Earlier charcoal haemoperfusion in fulminant hepatic failure. Lancet. 1982;2:681–683. doi: 10.1016/s0140-6736(82)90711-5. [DOI] [PubMed] [Google Scholar]
  • 24.O'Grady JG, Alexander GJM, Mayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97:439–445. doi: 10.1016/0016-5085(89)90081-4. [DOI] [PubMed] [Google Scholar]
  • 25.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. 1984;288:270–271. doi: 10.1136/bmj.288.6413.270. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Cock KM, Govindarajan S, Valinluck B, Redeker AG. Hepatitis B virus DNA in fulminant hepatitis B. Ann Intern Med. 1986;105:546–547. doi: 10.7326/0003-4819-105-4-546. [DOI] [PubMed] [Google Scholar]

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