Annicchiarico B E, Avolio A W, Siciliano M, Passalacqua S, Caracciolo G, Gasbarrini A, Agnes S, Castagneto M
Department of Internal Medicine, Catholic University, A. Gemelli Hospital, Rome, Italy.
Transplant Proc. 2008 Jul-Aug;40(6):1929-31. doi: 10.1016/j.transproceed.2008.05.064.
Various artificial liver support systems are currently used in patients with decompensated chronic liver disease or acute liver failure as a bridge to recovery or to orthotopic liver transplantation (OLT). Between June 2004 and September 2006, 9 subjects were treated with plasma exchange (PE) for acute decompensation on chronic liver disease or chronic decompensation in end-stage liver disease. All of them were awaiting OLT or were listed at the moment of decompensation. Grade II to III hepatic encephalopathy (HE) was present in 4 patients, significant renal dysfunction in 3 patients, and ascites in 6 patients. Baseline serum total bilirubin was 35.1+/-11.2 mg/dL (mean value+/-SD). The patients underwent a mean of 12.1 2-hour exchanges over 1 to 8 weeks. The 3 who recovered were alive after a mean follow-up of 22.7+/-10.3 months. There were 3 patients who underwent transplantation and 3 who died due to liver failure during treatment. Only subjects with acute decompensation and without HE or significant renal dysfunction survived without OLT. PE did not significantly modify the grade of HE or the renal function. PE seemed to be a safe, long-term, effective therapeutic option for acute decompensation among subjects with chronic liver disease without brain or renal dysfunction.
目前，各种人工肝支持系统被用于失代偿期慢性肝病或急性肝衰竭患者，作为恢复或原位肝移植（OLT）的桥梁。在2004年6月至2006年9月期间，9名患者因慢性肝病急性失代偿或终末期肝病慢性失代偿接受了血浆置换（PE）治疗。他们均在等待OLT或在失代偿时被列入名单。4例患者出现II至III级肝性脑病（HE），3例患者有明显肾功能不全，6例患者有腹水。基线血清总胆红素为35.1±11.2mg/dL（平均值±标准差）。患者在1至8周内平均接受了12.1次2小时的置换。3例康复患者在平均随访22.7±10.3个月后仍存活。有3例患者接受了移植，3例在治疗期间因肝衰竭死亡。只有急性失代偿且无HE或明显肾功能不全的患者在未进行OLT的情况下存活。PE并未显著改变HE的分级或肾功能。对于无脑部或肾功能障碍的慢性肝病患者的急性失代偿，PE似乎是一种安全、长期、有效的治疗选择。
