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LIVER DIALYSIS IN TREATMENT OF HEPATIC FAILURE AND HEPATORENAL FAILURE: RANDOMIZED CLINICAL TRIALS AND CLINICAL EXPERIENCE

Ash, S R1,2,3; Kuczek, T4; Blake, D E2; Gingrich, C H2

ASAIO Renal Abstracts
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1Comparative Medicine, Purdue University

2HemoCleanse, Inc., W. Lafayette, IN

3Arnett Clinic, Lafayette, IN

4Dept of Statistic, Purdue University

The Liver Dialysis Unit is a currently marketed artificial liver that employs hemodiabsorption (dialysis of blood against powdered sorbent) to remove the numerous small molecular weight toxins of hepatic failure. A randomized, prospectively controlled study of Liver Dialysis in treatment of hepatic failure was performed in 5 centers. Entry criteria were: decrease in hepatic function associated with Stage 2–4 encephalopathy, renal failure or respiratory failure allowed, but not already on dialysis or CVVH Another 28 patients were treated in crossover studies. Most patients had stage IV encephalopathy, renal insufficiency, and respiratory insufficiency or failure. Of the 75 patients, 32 had fulminant hepatic failure (FHF), and 43 had acute-on-chronic failure. Liver Dialysis (6 hrs, 3–5 days) significantly improved neurologic (70%) and physiologic status (72%) of all patients vs. control groups (27% and 10% respectively). Liver Dialysis significantly improved patient outcome (improvement of condition for transplant or recovery of liver function) for patients with A-on-C (57%) vs. control patients (36%), though not for FHF patients. In 32 patients with hepatic and renal failure on entry, Liver Dialysis significantly improved patient outcome (41%) vs. control patients (0%). Since market introduction, more than 50 patients, mostly A-on-C have been treated in many hospitals for hepatic failure, with 58% positive outcome, confirming the above studies. The suspension is easily modified by adding dry powdered chemicals to the sorbent bag. Branched chain amino acids added to the sorbent result in a greater increase in Fischer's ratio during treatment, and new ammonium sorbents increase the removal of ammonium. Clinical effects of Liver Dialysis in treatment of hepatic failure may be further hastened and augmented by these improvements.

Copyright © 2000 by the American Society for Artificial Internal Organs