Push-pull sorbent-based pheresis and hemodiabsorption in the treatment of hepatic failure: preliminary results of a clinical trial with the BioLogic-DTPF System.
The BioLogic-DTPF System combines hemodiabsorption (the BioLogic-DT System with dialysis against powdered sorbent) with push-pull sorbent-based pheresis (the BioLogic-PF System with powdered sorbent surrounding plasma filters). At blood flow rates of 200 ml/min, the system clears creatinine and aromatic amino acids at 120-160 ml/min, unconjugated bilirubin at 20-40 ml/min, and cytokines at 15-25 ml/min. This article outlines a study of the DTPF System in treatment of patients with hepatic failure with Grade 3 or 4 encephalopathy and respiratory and kidney insufficiency. Treatment appeared to be safe, and there are no significant hematologic changes. Physiologic changes include improved blood pressure and encephalopathy and stable urine output. Chemical changes include decrease in plasma levels of bilirubin, aromatic amino acids, ammonium, creatinine, and interleukin-3 (IL-1beta). The BioLogic-DT System is now marketed for treatment of acute hepatic failure with encephalopathy. The BioLogic-DTPF System adds the capability of removing bilirubin and other strongly protein-bound toxins from treated patients and may be of clinical benefit in management of patients with the most severe hepatic failure and encephalopathy.
Ash
S R
SR
Purdue University, Department of Comparative Medicine, West Lafayette, Indiana, USA. sash@hemocleanse.com
Steczko
J
J
Knab
W R
WR
Blake
D E
DE
Carr
D J
DJ
Harker
K D
KD
Levy
H
H
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001783:Blood Flow Velocity; D003404:Creatinine / Q000097:blood; D016207:Cytokines / Q000097:blood; D004867:Equipment Design; D005260:Female; D017583:Hemodiafiltration / Q000295:instrumentation / Q000379:methods*; D006501:Hepatic Encephalopathy / Q000097:blood / Q000145:classification / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications; D012131:Respiratory Insufficiency / Q000150:complications; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000596:Amino Acids; D016207:Cytokines; D003404:Creatinine; D001663:Bilirubin