Temporary extracorporeal liver support for severe acute alcoholic hepatitis using the BioLogic-DT.
Patients with severe acute alcoholic hepatitis develop multiple organ failure which is associated with production of inflammatory cytokines and a poor prognosis. The aim of the present pilot study was to evaluate the effects of the BioLogic-DT sorption-suspension dialyser in patients with severe acute alcoholic hepatitis. Ten patients with encephalopathy (grade II-IV) were entered into the study, 5 received treatment with the BioLogic-DT for 6 hours daily for 3 days and 5 received conventional treatment as controls. The system was biocompatible with no adverse effects on blood pressure or platelet counts, factor V, fibrinogen or antithrombin III. No bleeding episodes were observed even with the use of small doses of heparin. After 3 days, blood ammonia was lower in the BioLogic-DT treated patients than in the controls, although blood lactate was higher. There were slight increases in plasma TNF and IL-8 during treatment over and above the higher levels present initially, possibly as a result of activation of white cells in the extracorporeal circuit. The further development of the BioLogic-DT dialyser with the addition of a plasma treatment module capable of removing cytokines would be worth evaluating in acute alcoholic hepatitis.
Ellis
A J
AJ
Institute of Liver Studies, King's College Hospital and School of Medicine and Dentistry, London, UK.
Hughes
R D
RD
Nicholl
D
D
Langley
P G
PG
Wendon
J A
JA
O'Grady
J G
JG
Williams
R
R
D000208:Acute Disease; D000328:Adult; D000641:Ammonia / Q000097:blood; D001672:Biocompatible Materials; D001777:Blood Coagulation; D016207:Cytokines / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000209:etiology / Q000628:therapy; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000150:complications / Q000628:therapy*; D006801:Humans; D016209:Interleukin-8 / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D001672:Biocompatible Materials; D016207:Cytokines; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D019344:Lactic Acid; D000641:Ammonia