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Continuous Renal Replacement Therapy (CRRT) in Liver Failure and Other Liver Assist Devices

  • Bogdana Sabina Zoica
  • Ayse Akcan-Arikan
  • Akash Deep
Chapter

Abstract

Liver failure, both acute (ALF) and acute-on-chronic liver failure (ACLF), present unique challenges in critical care, especially in children. Advances in medical technology and orthotopic liver transplantation (OLT) have improved overall survival in pediatric liver failure (LF). Blood purification in the form of combined extracorporeal therapy is often necessary to support the multiple organ failure associated with a failing liver either as a bridge to spontaneous regeneration or successful liver transplantation. Different therapies using extracorporeal liver assist devices (ECLD) as well as challenges such as circuit anticoagulation will be discussed after a brief review of pathophysiology as context for extracorporeal therapy use in pediatric LF.

Keywords

Liver failure Continuous renal replacement therapy Liver support Acute kidney injury 

Abbreviations

AC

Ammonia clearance

ALF

Acute liver failure

ACLF

Acute on chronic liver failure

AKI

Acute kidney injury

CE

Cerebral edema

CRRT

Continuous renal replacement therapy

CVVH

Continuous veno-venous hemofiltration

CVHD

Continuous veno-venous hemodialysis

CVVHDF

Continuous veno-venous hemodiafiltration

ECLD

Extracorporeal liver assist devices

FFP

Fresh frozen plasma

GFR

Glomerular filtration rate

HE

Hepatic encephalopathy

HRS

Hepatorenal syndrome

HVHF

High volume hemofiltration

ICP

Intracranial pressure

LF

Liver failure

MARS

Molecular absorbing recirculating system

OLT

Orthotopic liver transplantation

RCA

Regional citrate anticoagulation

SPAD

Single pass albumin dialysis

TPE

Total plasma exchange

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Bogdana Sabina Zoica
    • 1
  • Ayse Akcan-Arikan
    • 2
    • 3
  • Akash Deep
    • 1
  1. 1.Pediatric Intensive Care, King’s College HospitalLondonUK
  2. 2.Department of PediatricsSections of Critical Care and Nephrology, Texas Children’s HospitalHoustonUSA
  3. 3.Critical Care Nephrology, Texas Children’s HospitalHoustonUSA

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