title: Multicenter study of plasma diafiltration in patients with acute liver failure.
abstract: Plasma diafiltration (PDF) is a blood purification therapy in which simple plasma exchange (PE) is performed using a selective membrane plasma separator while the dialysate flows outside the hollow fibers. A prospective, multicenter study was undertaken to evaluate the changes in bilirubin, IL-18, and cystatin C, as well as the 28-day and 90-day survival rates, with the use of PDF according to the level of severity as measured by the Model for End-Stage Liver Disease (MELD) score. Twenty-one patients with liver failure were studied: 10 patients had fulminant hepatitis and PDF therapies were performed 28 times; 11 had acute liver failure with the therapy performed 96 times. Levels of total bilirubin, IL-18, and cystatin C decreased significantly after treatment. The 28-day survival rate was 70.0% and that at 90 days was 16.7%. According to the severity of the MELD score, each of the results compared well with the use of Molecular Adsorbent Recirculating System or Prometheus therapy. In conclusion, PDF appears to be one of the most useful blood purification therapies for use in cases of acute liver failure in terms of medical economics and the removal of water-soluble and albumin-bound toxins.
authors.affiliation: Department of Emergency and Critical Care Medicine, Akita University School of Medicine, Hondo, Akita 010-8543, Japan. nakaeh@doc.med.akita-u.ac.jp
authors.forename: Hajime
authors.initials: H
authors.lastname: Nakae
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Takao
authors.initials: T
authors.lastname: Saotome
authors.forename: Toyokazu
authors.initials: T
authors.lastname: Yoshioka
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kishi
authors.forename: Toshio
authors.initials: T
authors.lastname: Naka
authors.forename: Tomoki
authors.initials: T
authors.lastname: Furuya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000378:metabolism*; D055316:Cystatin C / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D020382:Interleukin-18 / Q000378:metabolism; D017114:Liver Failure, Acute / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
chemical_list: D055316:Cystatin C; D020382:Interleukin-18; D001663:Bilirubin