title: High-flow-rate haemodiafiltration as a brain-support therapy proceeding to liver transplantation for hyperacute fulminant hepatic failure.
abstract: In fulminant hepatic failure (FHF), rapidly progressive cerebral oedema remains the main fatal complication and an obstacle in liver transplantation. A 29-year-old Japanese woman presented with sudden-onset hepatic encephalopathy and jaundice. Hepatic encephalopathy deteriorated within 2 days of the onset of jaundice. She manifested extensory sustained clonus and was responsive only to pain. Diffuse cerebral oedema was noted on brain computerized tomography (CT) scan. Urgent living-donor liver transplantation (LDLT) at the time of admission was abandoned because of deterioration of neurological status and radiologically evident diffuse cerebral oedema. Instead, a high-flow-rate (7.2-9.0 l/h) haemodiafiltration with a high-performance membrane was commenced, combined with plasma exchange. This treatment regimen resulted in a gradual improvement of hepatic encephalopathy and complete disappearance of cerebral oedema within 7 days. Liver regeneration did not occur during this period, as evident by CT scan volumetry and serological tests. LDLT was subsequently performed using the right liver lobe of the patient's brother. Our case suggests that high-flow-rate haemodiafiltration with a high-performance membrane, combined with plasma exchange, could potentially be brain-support therapy for patients with FHF, and may contribute, when combined with liver transplantation, to the improvement of prognosis in hyperacute FHF.
authors.affiliation: First Department of Surgery, Okayama University School of Medicine, Okayama 700, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sadamori
authors.forename: Takahito
authors.initials: T
authors.lastname: Yagi
authors.forename: Masaru
authors.initials: M
authors.lastname: Inagaki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsuda
authors.forename: Noriaki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Kohsaku
authors.initials: K
authors.lastname: Sakaguchi
authors.forename: Takao
authors.initials: T
authors.lastname: Tsuji
authors.forename: Masaki
authors.initials: M
authors.lastname: Matsumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Katayama
authors.forename: Norihisa
authors.initials: N
authors.lastname: Hirakawa
mesh_terms: D000328:Adult; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002545:Brain Ischemia / Q000517:prevention & control*; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006501:Hepatic Encephalopathy / Q000150:complications / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D010951:Plasma Exchange; D014057:Tomography, X-Ray Computed