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

  • G. Brunner
  • J. Bahlmann
  • G.-M. Eisenbach


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].


Femoral Artery Plasma Exchange Fresh Freeze Plasma Juvenile Rheumatoid Arthritis Fulminant Hepatic Failure 
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  1. 1.
    Akamatsu K, Tanaka Y, Tada K, Okada S, Mukai J, Hashimoto H, Ohkubo H, Ohta Y (1983) Pulmonary microembolism due to the exchange transfusion of fresh-frozen-plasma containing microaggregates. In: Oda T (ed) Therapeutic plasmapheresis III. Schattauer, Stuttgart, pp. 95–100Google Scholar
  2. 2.
    Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2: 319–323PubMedCrossRefGoogle Scholar
  3. 3.
    Aufeuvre JP, Morin-Hertel F, Cohen-Solal M, Lefloch A, Baudelot J (1980) Hazards of plasma exchange. A nationwide study of 3431 exchanges in 591 patients. In: Siebert HG (ed) Plasma exchange. Schattauer, Stuttgart, pp. 149–57Google Scholar
  4. 4.
    Brandstetter RD (1986) The adult respiratory distress syndrome. Heart Lung 15: 155–164PubMedGoogle Scholar
  5. 5.
    Brewer E, Nickeson R, Rossen R, Person D, Giannini E, Milam J (1981) Plasma exchange in selected patients with juvenile rheumatoid arthritis. J Pediatr 98: 194PubMedCrossRefGoogle Scholar
  6. 6.
    Brunner G, Lösgen H (1985) Artificial liver support. Leber Magen Darm 15 No 5: 186–191PubMedGoogle Scholar
  7. 7.
    Bussel A, Sitthy X, Revirón J (1983) Technical aspects and complications of plasma exchange. Ric Clin Lab 13: 111PubMedGoogle Scholar
  8. 8.
    Dhainaut J, Brossard Y, Dimercurio J, Maigret P, Chavigne J, Vacher Lavenu M, Class, van Rood J, Monsallier J (1981) Oedème pulmonaire lésionnel gravissime au cours du 20 échange plasmatique pour incompatibilité Rhésus. Journées Provinciales de la Société de Réanimation de Langue Française, Lille, 7–9 mai 1981. In: Hémoperfusion. Echange plasmatique en réanimation. Expansion Scientifique Française, Paris, pp. 290–298Google Scholar
  9. 9.
    Fowler AA, Hamman RF, Good JT, Benson KN, Baird M, Eberle DJ, Petty TL, Hyers TM (1983) Adult respiratory distress syndrome: risk with common predispositions. Ann Intern Med 98: 593–597PubMedGoogle Scholar
  10. 10.
    Frey-Wettstein M, Hoppler R (1976) Mikroaggregate in Lagerblut. Schweiz Med Wochenschr 106: 1436–8PubMedGoogle Scholar
  11. 11.
    Lepore MJ, Martel AJ (1967) Plasmapheresis in hepatic coma. Lancet 2: 771CrossRefGoogle Scholar
  12. 12.
    Lepore JJ, Stutman LJ, Bonanno CA, Conklin EF, Robilotti JG, McKenna PJ (1972) Plasmapheresis with plasma exchange in hepatic coma II: fulminant viral hepatitis as a systemic disease. Arch Intern Med 129: 900–7PubMedCrossRefGoogle Scholar
  13. 13.
    Lysaght MJ, Gurland HJ (ed) (1983) Plasma separation and plasma fractionation. Karger, Basel 248Google Scholar
  14. 14.
    Sieberth HG (ed) (1980) Plasma exchange. Schattauer, StuttgartGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • G. Brunner
  • J. Bahlmann
  • G.-M. Eisenbach

There are no affiliations available

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