Haemodynamic changes after high-volume plasmapheresis in patients with chronic and acute liver failure.
OBJECTIVE
To evaluate the haemodynamic changes during treatment with high-volume plasmapheresis in patients with chronic liver failure compared to patients with acute liver failure.


METHODS
Haemodynamic measurements were performed with a Swan-Ganz catheter and thermodilution technique. High-volume plasmapheresis (mean plasma exchange of 8.6 litres) was performed in 11 patients with chronic and 16 patients with acute liver failure.


RESULTS
In patients with chronic liver failure, systemic vascular resistance index was unaltered: 1193 +/- 494 dynscm-5m2 before treatment versus 1180 +/- 399 dynscm-5m2 after. Mean arterial pressure increased from 69 +/- 11 mmHg to 78 +/- 13 mmHg (P < 0.05) and cardiac output increased from 8.1 +/- 2.4 l/min to 8.9 +/- 2.4 l/min (P < 0.05) during high-volume plasmapheresis. In patients with acute liver failure, systemic vascular resistance index increased from 1154 +/- 628 dynscm-5m2 to 1614 +/- 738 dynscm-5m2 (P < 0.001). In this group mean arterial pressure increased from 78 +/- 16 mmHg to 95 +/- 10 mmHg (P < 0.001) and cardiac output decreased from 9.6 +/- 3.7 l/min to 8.2 +/- 2.9 l/min (P < 0.01).


CONCLUSIONS
The hyperkinetic circulation in chronic and acute patients was differently affected by high-volume plasmapheresis. We suggest that in chronic liver failure both portosystemic shunting and chronic peripheral vasodilation may contribute to the hyperkinetic syndrome, whereas in acute liver failure a humoral factor which can be removed by high-volume plasmapheresis is a main contributor.
Clemmesen
J O
JO
Department of Hepatology, Rigshospitalet, University of Copenhagen, Denmark.
Larsen
F S
FS
Ejlersen
E
E
Schiødt
F V
FV
Ott
P
P
Hansen
B A
BA
D000208:Acute Disease; D000328:Adult; D001663:Bilirubin / Q000097:blood; D001784:Blood Gas Analysis; D002405:Catheterization, Central Venous; D002908:Chronic Disease; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008102:Liver Circulation; D017093:Liver Failure / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012121:Respiration, Artificial; D016896:Treatment Outcome
D006454:Hemoglobins; D001663:Bilirubin