Use of On-Line Hemodiafiltration for Fulminant Hepatic Failure

Abstract

Various artificial liver support systems were developed for the purpose of the removal of the toxic factorsin acute liver failure. Though CHDF and HDF are chosen at present to remove ammonia and middle-sizedmolecules which have been thought to be responsible for hepatic coma, we introduced on-line HDF from thepoint of the case of handling, high efficiency and economical benefits. On-line HDF was carried out safelywithout infectious complications and it was useful for improvement in the level of consciousness of thepatients even under conditions in which the abolition of liver function had been estimated. The dosedependenteffects of on-line HDF recognized in treatment for renal replacement are expected also in thetreatment of acute liver failure. On the other hand, the frequency of the plasma exchange supplementingplasma proteins, especially coagulation factors, is limited by the health insurance costs and that obstructsgiving adequate treatment to assist liver function. This is a major problem which should be open to publicdiscussion.