The treatment of acute liver failure with fractionated plasma separation and adsorption system: Experience in 85 applications.
BACKGROUND
Artificial liver support systems represent a potential useful option for the treatment of liver failure. The outcomes of patients treated with the fractionated plasma separation and adsorption (FPSA) system are presented.


METHODS
FPSA was performed 85 times for 27 patients (median 3 treatments/patient) with liver failure [85.2% acute liver failure (ALF) and 14.8% acute-on-chronic liver failure] using the Prometheus 4008H (Fresenius Medical Care) unit. Citrate was used for anticoagulation. A variety of clinical and biochemical parameters were assessed. Comparisons between pretreatment and post-treatment data were performed using paired t-test.


RESULTS
The 85 sessions had a mean duration of 6 h. There were significant decreases in total bilirubin (13.18 +/- 9.46 mg/dL vs. 9.76 +/- 7.05 mg/dL; P < 0.0001), ammonia (167.6 +/- 75 mg/dL vs. 120 +/- 43.8 mg/dL; P < 0.0001), blood urea nitrogen (BUN; 12.55 +/- 13.03 mg/dL vs. 8.18 +/- 8.15 mg/dL; P < 0.0001), creatinine (0.54 +/- 0.47 mg/dL vs. 0.46 +/- 0.37 mg/dL; P = 0.0022) levels, and in pH (7.48 +/- 0.05 vs. 7.44 +/- 0.08; P = 0.0045). Four patients (14.8%) received liver transplantation after the treatments; in nine patients, transplantation was not necessary anymore (33%); the remaining 14 patients did not receive a transplantation because they were either not appropriate candidates or no organ was available. Overall survival was 48.1% (4 transplanted and 9 treated patients). No hematological complications related to FPSA were observed.


CONCLUSIONS
FPSA system is a safe and effective detoxification method for patients with liver dysfunction, including ALF. The system is useful as a symptomatic treatment before liver transplantation; in up to 1/3 of the cases, it can even be used as a sole method of treatment.
Sentürk
Evren
E
Department of Anesthesiology, Istanbul Medical Faculty, Istanbul University, Capa, Istanbul, Turkey. evrensenturk2@yahoo.com
Esen
Figen
F
Ozcan
Perihan E
PE
Rifai
Kinan
K
Pinarbaşi
Binnur
B
Cakar
Nahit
N
Telci
Lutfi
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D001769:Blood / Q000378:metabolism; D005591:Chemical Fractionation; D002648:Child; D019343:Citric Acid; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010949:Plasma; D006435:Renal Dialysis / Q000379:methods*; D016060:Sorption Detoxification / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
D019343:Citric Acid