Plasma separation and bilirubin adsorption after complicated liver transplantation: a therapeutic approach to excessive hyperbilirubinemia.
BACKGROUND
Severe hyperbilirubinemia is known to exert multiple toxic effects. Thus, a reduction in bilirubin by use of various adsorbent columns has been reported for a variety of hepatic disorders, but no experience with liver transplant patients is available as yet.


METHODS
Plasma separation and bilirubin adsorption by an anion-exchange adsorbent column (BR-350) were performed in two patients with severe jaundice (total serum bilirubin > 55 mg/dl) and multiple organ failure that had developed after orthotopic liver transplantation.


RESULTS
The procedure resulted in an 18% to 35% reduction in total bilirubin after each session, accompanied by a remarkable clinical improvement. Both patients finally recovered and had a favorable outcome. No complications or side effects of bilirubin adsorption were observed during any of the six sessions.


CONCLUSIONS
Bilirubin adsorption is a safe and effective treatment. It should be considered as supportive therapy for excessive hyperbilirubinemia after liver transplantation. In selected cases, retransplantation may thus be avoided.
Ott
R
R
Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
Rupprecht
H
H
Born
G
G
Müller
V
V
Reck
T
T
Hohenberger
W
W
Köckerling
F
F
D000327:Adsorption; D001663:Bilirubin / Q000097:blood* / Q000302:isolation & purification; D005260:Female; D006440:Hemofiltration; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology / Q000628:therapy*; D007565:Jaundice / Q000209:etiology / Q000628:therapy*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D011183:Postoperative Complications / Q000628:therapy*; D012121:Respiration, Artificial
D001663:Bilirubin