INDICATION AND LIMITATION OF ARTIFICIAL LIVER SUPPORT (ALS) WITH HEMOPURIFICATION FOR ACUTE HEPATIC FAILURE (AHF)

Abstract

Since liver transplantation has not yet been clinically available in Japan, ALS with various hemopurifications remains to be a mainstay of the treatment. The indication of ALS should be decided according to the hepatocellular function. The criteria to initiate ALS are 1) arterial ketone body ratio<0.7, and 2) hepaplastin test<30% or total bilirubin>5mg/dl, and 3) depressed consciousness level or osmolality gap>2mOsm/kg/H₂O. The combination of plasma exchange, plasma adsorption and continuous hemofiltration is effective and useful as ALS for AHF.