Abstract
We have been treating patients with fulminant hepatic failure (FHF) by applying various kinds of apheresis treatment. In this investigation, 29 patients with FHF were treated. The series included 15 cases of the acute type and 14 cases of the sub-acute type. Total number of treatment were as follows. Plasma exchange (PE) was performed 151 times. Cryofiltration (Cryo) was performed 55 times. Hemo-dialysis (HD) and hemo-dia-filtration (HDF) were performed many times as hepatic support. Ten patients survived. The overall survival rate was 34.5% (acute type 40.0%, sub-acute type 28.6%). Cryo was seen to be effective in 2 cases with FHF who showed hyper-bilirubinemia after PE. Liver volume calculated by CT and brain edema were correlated to survival rate. Survival was difficult for patients whose liver volume had decreased to less than 700cm3 and whose brain edema had progressed. HD and/or HDF were very useful for maintaining homeostasis in patients, specifically in terms of water and pH balance. The beneficial effects of PE with HD and/or HDF have been evident in FHF. These treatments should be applied at the appropriate stage in the clinical course of FHF.
