Abstract
An anion exchange resin (Ionex) capable of removing bilirubin and bile acids has been developed for use in artificial liver support systems and has been demonstrated to be effective in reducing serum bilirubin and bile acids experimentally and clinically in cases of hyperbilirubinemia. However, fibrin clots and platelet aggregates on the surface of the resin were problems in direct hemoperfusion. To overcome this problem we investigated the effect of on-line connection of a plasma separator (Plasmax, Toray Inc., Tokyo) with the anion exchange resin. The results of a hemoperfusion experiment showed that the Plasmax system yielded good plasma separation. Furthermore in an experiment in a group of 10 hyperbilirubinemic dogs this system obtained good removal of bilirubin and bile acids. Absorption rate by this combined system was no different from that of direct hemoperf usion, and during extracorporeal circuration there was no increase of perfusion pressure or any clot formation. In clinical cases of postoperative hyperbilirubinemia the adsorption of bilirubin and bile acid was poorer than in the experimental model, but there were no problems in terms of extracorporeal circuration.
