Assessment of bilirubin clearance capacity of a newly developed ion-exchange adsorption column and its possible use as a supportive therapy in hepatorenal syndrome.
We assessed the bilirubin reduction capacity of three different types of devices in vitro: a high-permeable membrane column for double-filtration plasmapheresis (DFP) (Evaflux 2A, Kuraray, Japan), and non-coated charcoal column for hemoperfusion (HP) (N-180, Asahi Medical, Japan), and ion-exchange columns for plasma adsorption (PA) (BR-350, Asahi Medical, Japan, and B-001, Kuraray, Japan). A column for DFP reduced the concentration of low-molecular proteins effectively such as plasma bilirubin and bile acids in an albumin-dependent manner. A charcoal column adsorbed low-molecular substances preferentially. But in these two columns, the loss of fibrinogen is a limiting factor for determining the processing plasma volume. Ion-exchange columns for PA adsorbed bile acids, disconjugated bilirubin, and monoconjugated bilirubin more efficiently compared with delta-bilirubin and unconjugated bilirubin. Pretreatment of the column with heparin reduced the loss of fibrinogen to less than 10%. We applied the BR-350 ion-exchange column in vivo for treatment of three patients with hyperbilirubinemia. After treatment, an alcoholic hepatitis patient with the hepatorenal syndrome (HRS) recovered from acute renal failure. However, in a patient with primary biliary cirrhosis and in a patient with fulminant hepatitis, the decrease of serum bilirubin was transient and no obvious beneficial responses were noted. The capacity and ability of the BR-350 column to adsorb plasma bilirubin was shown sufficient to treat deeply jaundiced patients, because 4 liters of the plasma of a patient with 108 mg/dl of initial total bilirubin concentration was able to be processed continuously without an obvious decrease in bilirubin adsorption capacity.(ABSTRACT TRUNCATED AT 250 WORDS)
Sone
J
J
First Department of Internal Medicine, Kochi Medical School, Japan.
Saibara
T
T
Himeno
H
H
Yamasaki
K
K
Miyamoto
K
K
Maeda
T
T
Onishi
S
S
Yamamoto
Y
Y
Park
K
K
Okumiya
T
T
D000327:Adsorption; D001663:Bilirubin / Q000097:blood*; D002852:Chromatography, Ion Exchange; D006440:Hemofiltration; D006464:Hemoperfusion; D006505:Hepatitis / Q000097:blood / Q000628:therapy; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000628:therapy; D006530:Hepatorenal Syndrome / Q000097:blood / Q000628:therapy; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000097:blood / Q000628:therapy; D010956:Plasmapheresis
D001663:Bilirubin