2011 Volume 2 Issue 1 Pages 47-51
Combination of plasma exchange (PE) and hemodiafiltration (HDF) was performed as an artificial liver support (ALS) for fulminant hepatic failure. The indication of PE according to national health insurance was limited to 10 times for fulminant hepatitis（FH）and 7 times for acute liver failure (ALF). Although the simple PE was not enough to recovery from hepatic coma, HDF was combined to purify the middle molecules included causal substances of hepatic coma. Extended daily HDF was performed with high volume filtrate (2～3L/hr) and high flow dialysate (500mL/min). When the ALF was complicated to post operative/traumatic or septic patients, the simple HDF during transfusion of fresh frozen plasma was started before PE. The indication of HDF according to national health insurance was limited to 10 times in month for 3 months. The mortality rates in our hospital were 54％ in 68 cases of FH and 68％ in 38 cases of ALF. While the ALS for FH was started from severe type of acute hepatitis, it should be started early for ALF in cases with thrombocytopenia.
