Inoue K, Kourin A, Watanabe T, Yamada M, Yoshiba M
Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan.
Transplant Proc. 2009 Jan-Feb;41(1):259-61. doi: 10.1016/j.transproceed.2008.10.058.
Fulminant hepatitis is an intractable disease of varying etiology. Artificial liver support (ALS) is used to control serious symptoms of fulminant hepatitis, such as brain edema, which may induce postoperative neurological deficits.
ALS was evaluated in 12 patients with fulminant hepatitis who had been placed on an ALS system comprising plasma exchange and online hemodiafiltration. Six of 12 patients fell into an ahepatic state, the absolute indication for liver transplantation. The effects of ALS were evaluated on the basis of improvements in clinical symptoms, removal of glutamine (Gln), and brain computed tomography.
All 12 patients regained consciousness with ALS and 5 survived; 7 died despite recovering from hepatic coma. The ALS systems sustained patients in an ahepatic state for more than 2 weeks. The median estimated plasma equivalent volume of removed Gln was 17.9 L (range, 6.7-64.3 L). There was a significant relationship between total buffer volume and the plasma equivalent volume of removed Gln.
Plasma exchange combined with hemodiafiltration using large buffer volumes is a promising and effective bridging method to liver transplantation.
暴发性肝炎是一种病因各异的难治性疾病。人工肝支持（ALS）用于控制暴发性肝炎的严重症状，如脑水肿，脑水肿可能导致术后神经功能缺损。
对12例接受了包括血浆置换和在线血液透析滤过的ALS系统的暴发性肝炎患者进行了评估。12例患者中有6例进入无肝状态，这是肝移植的绝对指征。基于临床症状的改善、谷氨酰胺（Gln）的清除以及脑部计算机断层扫描评估了ALS的效果。
所有12例患者通过ALS恢复了意识，5例存活；7例尽管从肝昏迷中恢复过来但仍死亡。ALS系统使患者在无肝状态下维持了2周以上。Gln清除的估计血浆当量体积中位数为17.9 L（范围为6.7 - 64.3 L）。总缓冲液体积与Gln清除的血浆当量体积之间存在显著关系。
使用大量缓冲液的血浆置换联合血液透析滤过是一种有前景且有效的肝移植桥接方法。
