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High recovery rate of consciousness by high‐volume filtrate hemodiafiltration for fulminant hepatitis
Author(s) -
Fujiwara Keiichi,
Abe Ryuzo,
Yasui Shin,
Yokosuka Osamu,
Kato Naoya,
Oda Shigeto
Publication year - 2019
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13255
Subject(s) - medicine , fulminant hepatitis , hepatic encephalopathy , liver transplantation , encephalopathy , hepatitis , recovery rate , fulminant hepatic failure , liver failure , gastroenterology , surgery , transplantation , chemistry , chromatography , cirrhosis
Aim An artificial liver support (ALS) system sustaining patients with acute liver failure (ALF) in good condition until recovery of the native liver or performance of liver transplantation (LT), is essential for the improvement of the poor prognosis of ALF despite the lack of survival benefit. We aimed to investigate the efficacy of various ALS systems for fulminant hepatitis (FH) carried out in our liver unit so far, focusing on the restoration of consciousness from hepatic encephalopathy. Methods One hundred and ten consecutive adult Japanese patients with FH admitted to Chiba University Hospital (Chiba, Japan) between 1988 and 2016 who received ALS were analyzed. Results Recovery rate of consciousness improved with the increased dialysate flow rate and filtrate rate: 37.5% by plasma exchange (PE), 51.9% by PE + continuous hemodiafiltration (CHDF), 57.7% by slow PE (sPE) + high‐flow CHDF (HFCHDF) (Q D = 300 mL/min), 88.6% by HFCHDF (Q D = 500 mL/min) (+ sPE), and 92.9% by on‐line HDF (OLHDF) (+ sPE). All patients except one, who could not be fully treated because of circulatory failure, recovered consciousness by OLHDF, including those whose liver function were completely abolished. Superiority of HFCHDF (Q D = 500 mL/min) and OLHDF was also shown in patients who died without LT or received LT. Conclusions More effective ALS should be recognized considering the extremely high recovery rate of consciousness. In particular, OLHDF with predilution reduces the cost of substitution fluid by supplying an unlimited amount of dialysate as substitution fluid prepared using an on‐line system, and simplifies the procedure for the management.