Removal of Bilirubin from Blood by Affinity-Competition Chromatography over Albumin-Agarose Gel

Abstract

Largely as the result of advances in artificial kidney design, there have been dramatic improvements in the well-being and survival of patients with acute and chronic renal disease during the past several decades (Klebba et al., 1974; Maher et al.,1974). In contrast, despite the introduction of numerous new therapeutic approaches, there has been little improvement over the same period in the survival of patients with acute fulminant hepatic failure (Benhamou et al.,1972). As a result of the continuing bleak prognosis for this condition, hepatologists are increasingly considering the feasibility of some sort of artificial device to perform temporarily some of the excretory functions of an acutely failing liver (Berk et al., 1976a, 1976b). Both laboratory and clinical interest has focused on extracorporeal perfusion through columns of sorbents such as charcoal or synthetic resins, which remove a wide range of molecular species from blood with variable efficiency and relatively low specificity. In the setting of fulminant hepatic failure, the low specificity of such systems is, in a sense, desirable since the particular biochemical abnormalities requiring correction are not precisely known (Breen and Schenker, 1972; Schenker et al., 1974; Fischer, 1974; Zieve, 1975). The most extensive clinical experience has been with charcoal hemoperfusion (Chang, 1972; Chang and Migchelson, 1973; Gazzard et al.,1974a; Williams, 1976), but in view of the lack of suitable randomized controls, the effectiveness of this procedure remains unclear (Berk et al., 1976a).