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To evaluate the efficacy of blood purification by plasma exchange in patients with liver failure, blood levels of total bilirubin and total bile acids, known to be a part of protein-bound toxins, were measured before and after plasma exchange. With one plasma volume exchange the percent reduction was 39 for bilirubin and only 25 for bile acids. The declining of the reduction efficiency appeared to be well correlated with the prolongation of the treatment time for bilirubin and the augmentation of the initial concentration for bile acids. These data suggested that the equilibration between intra-and extra-vascular pool takes place slowly for bilirubin and comparatively rapidly for bile acids, though they are both mostly bound to albumin in the blood. In addition, the presence of protein-bound toxins like bile acids, predominantely accumulated in the tissue, may make it more difficult to support patients with liver failure by only blood purification therapy with plasma exchange.

Blood purification of bilirubin and bile acids by plasma exchange for patients with liver failure.