[The beneficial effects of cross-hemodialysis on the patients with hepatic failure as reflected in the changes in blood ketone body ratio and plasma aminogram].
To evaluate the effects of cross-hemodialysis using pig or baboon liver in patients with hepatic failure, the changes in blood ketone body ratio (KBR) and plasma aminograms of 11 patients who were subjected to cross-hemodialysis were studied. In the 6 cases whose KBR were more than 0.25 before cross-hemodialysis, most of the amino acids except for the branched chain amino acids (BCAA), aspartate, and glutamine were increased. After cross-hemodialysis, they tended to be decreased and the KBR of these patients recovered to more than 0.4. On the other hand, in the 5 cases whose KBR were less than 0.25 before cross-hemodialysis, most of the amino acids were extremely increased except in one case, and they tended to increase still more after cross-hemodialysis except for the aromatic amino acids (AAA). Serial measurement of the KBR and plasma amino acids of both the patient side and the perfused blood of the assistant liver during cross-hemodialysis in 3 cases revealed that the assistant liver removes the amino acids derived from the patients. The beneficial effects of cross-hemodialysis, that is, to elevate the KBR and to recover the patients from hepatic failure, are conjectured to be produced by the reduction of the hepatic energy-consuming substances such as amino acids. Furthermore, two fresh, two 12 hours preserved and one 24 hours preserved isolated pig livers were perfused with the amino acids imposed blood and the changes in the KBR and the plasma aminograms were studied to clarify the relationship between metabolic activity of the perfused liver and the KBR. In the cases of the fresh livers and 12 hours preserved livers, the amino acids, which were to be metabolized by the liver, decreased with time and the KBR was restored and maintained at more than 0.7. But in the case of the 24 hours preserved liver, the amino acids were not metabolized and the KBR was restored to nearly 0.7 only for a period of time, after which it decreased. These results suggest that it is necessary to keep the energy charge of the perfused livers high in order to maintain hepatic metabolic activity.
Koizumi
K
K
Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
D000368:Aged; D000596:Amino Acids / Q000097:blood*; D000818:Animals; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000628:therapy*; D006801:Humans; D007657:Ketone Bodies / Q000097:blood*; D008099:Liver; D008297:Male; D008875:Middle Aged; D010215:Papio; D010477:Perfusion; D006435:Renal Dialysis / Q000379:methods; D013552:Swine
D000596:Amino Acids; D007657:Ketone Bodies