Plasma exchange (PE) is considered to be essential for the treatment of fulminant hepatic failure. However, small or middle-sized abnormal molecular weight substances are suspected to be a cause of hepatic encephalopathy. We report three patients with fulminant hepatic failure who were treated without PE and discuss the role of PE in the treatment of fulminant hepatic failure. We performed continuous hemofiltration (CHF) in these three patients, using large quantities of filtration and fresh frozen plasma (FFP) transfusion. PE was not performed in any of these cases. All patients were conscious after the completion of their treatments. CHF is useful for treating encephalopathy caused by fulminant hepatic failure and may be an effective means of replacing the liver's normal antidotal functions. The method can be used to remove small and middlesize molecular weight substances that are suspected of being hepatic toxins. FFP transfusion is a viable alternative to the normal liver's synthetic functions. The outcome of the three patients presented here suggests that PE may not be needed for the treatment of fulminant hepatic failure. Instead, CHF and FFP transfusion may be critical for the treatment of fulminant hepatic failure.
