Extracorporeal blood purification in the management of patients with hepatic failure.
With the increasing success of orthotopic liver transplantation, the time has come for a reassessment of the role of extracorporeal blood purification in the management of patients with liver failure. In those patients with combined liver and kidney failure, both standard hemodialysis and the newer continuous renal replacement therapies have been found to be helpful in maintaining fluid, electrolyte, and acid base balance. In those patients with liver failure but without kidney dysfunction, extracorporeal purification techniques have been found useful for the removal of hepatic toxins and in facilitating the replacement of clotting factors. This review will outline the rationale and documented utility of a wide variety of blood purification modalities used in the management of patients with liver failure.
Kaplan
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Department of Medicine, University of Connecticut Health Center, Farmington 06032, USA.
Epstein
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M
D001774:Blood Chemical Analysis; D002851:Chromatography, High Pressure Liquid; D002986:Clinical Trials as Topic; D005374:Filtration / Q000379:methods*; D006464:Hemoperfusion / Q000379:methods; D006530:Hepatorenal Syndrome / Q000097:blood* / Q000628:therapy*; D006801:Humans; D017093:Liver Failure / Q000097:blood / Q000628:therapy; D008970:Molecular Weight; D010951:Plasma Exchange / Q000379:methods; D010956:Plasmapheresis; D011379:Prognosis; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods; D017582:Renal Replacement Therapy / Q000379:methods* / Q000592:standards