Improved Plasma Exchange for the Treatment of Fulminant Hepatic Failure by Plasma Replacement into the Femoral Artery

Abstract

Theoretically plasma exchange is an almost ideal method of artificial liver support. It supports major functions of the liver: synthesis, detoxification, and regulation. Plasma exchange was first applied for liver failure by Lepore in 1967 [11, 12]. However, before the availability of membrane plasma separation, plasma exchange was too labour intensive to be widely applied. Therefore true benefits and dangers could not be evaluated. With the introduction of continuous membrane plasma separation, this treatment experienced a true boom for numerous indications [13, 14]. When applied in fulminant liver disease early effects have been astonishing. The state of consciousness improves regularly and in many cases patients even wake up. Toxins are effectively removed and synthetic products replaced significantly (Tables 1, 2). However, the initial enthusiasm soon faded. Not only did plasma exchange not fullfil its expectations, but actually it frequently induced severe complications and decreased the survival rate. When only one plasma exchange is performed, complications are rare. However, complications increase when the treatment is repeatedly performed [7, 8]. The lung is one of the more sensitive organs in plasma exchange. Pulmonary edema and infiltrations have been reported and aggregates found in the lungs of multiexchanged patients [5, 8].