Use of Hemoadsorption in a Case of Severe Hepatic Failure and Hyperbilirubinemia

gional citrate anticoagulation (Multifiltrate CiCa ® , FMC, Bad Homburg, Germany) in combination with CytoSorb (CytoSorbents Inc., USA) added in predialyzer position was initiated to rebalance the excessive hyperbilirubinemia, hence to salvage kidney function at bilirubin levels reaching 39.5 mg/dL (GOT Dear Editor, Acute severe hepatic failure associated with persistent severe hyperbilirubinemia is a rare but life-threatening critical illness typically affecting multiple other organs including renal and cerebral function [1] . We report the case of a 59-yearold male patient with medical history of lymphoblastic lymphoma, adipositas permagna (BMI 43), steatohepatitis, arterial hypertension, renal cysts, and a preceding laparoscopic cholecystectomy. After completion of therapy with rituximab and bendamustine for lymphoblastic lymphoma, the patient presented for a follow-up check at our hospital. With respect to the lymphoma, there was no evidence for remaining tumor activity. However, laboratory testing revealed significantly elevated transaminases (GOT 241 U/L, GPT 196 U/L) as well as increased total bilirubin serum levels (2.3 mg/dL), while retention parameters were within the normal range. In the further course, active hepatitis B was diagnosed (viremia >100,000 copies/mL) and therapy with entecavir was initiated. On day 9 after admission, the patient developed acute kidney injury [2] (oliguria <0.2 mL/ kg/h, creatinine 2.79 mg/dL, Kidney Disease: Improving Global Outcomes [KEDIGO] level 3), and was admitted to the intensive care unit for escalation of therapy (application of maximum therapy, advanced monitoring and use of extracorporeal organ support). Continuous venovenous hemodiafiltration using reReceived: December 16, 2016 Accepted: March 10, 2017 Published online: March 30, 2017