The coma which develops during acute hepatic failure has been attributed to the accumulation of toxic metabolites such as ammonia, short chain fatty acids, mercaptans, aromatic amino acids and false neurotransmitters. To remove these “toxins”, the technique of membrane plasmapheresis with on-line plasma treatment with multiple sorbents has been developed and applied clinically. The system consists of cellulose acetate hollow fiber plasma separator, coated activated charcoal and an uncoated anion exchange resin. Five acute liver failure patients were treated for a total of 141 hours. Pre-post reductions were 31% for bilirubin, 37% for fatty acids and plasma molar ratio increased by 26%. Four of 5 regained consciousness and one is surviving. Treatment was expanded to include 5 primary biliary cirrhosis patients and one chronic renal failure patient with Alagille's disease. All 6 had intractable pururitus and elevated bile acid levels. They were treated for a total of 129 hours along with the reduction of serum bile acids with relief of pruritus. Repeated and long-term treatments are possible for acute and chronic hepatic insufficiency patients.
