Maggi U, Nita G, Gatti S, Antonelli B, Paolo R, Como G, Messa P, Rossi G
UO Chirurgia Generale e Trapianti di Fegato, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milano, Italy; Department of Digestive and Hepatobiliary Surgery, AP-HP, UFR de Médecine de 1'Université Paris XII-Créteil, France.
Transplant Proc. 2013 Sep;45(7):2715-7. doi: 10.1016/j.transproceed.2013.07.019.
Hyperbilirubinemia often accompanies liver failure; therefore, artificial liver support devices are currently used as a bridge to more definitive treatments to eliminate water-soluble and albumin-bound toxins. We report 2 patients, of which, after liver transplantation, the first experienced early allograft dysfunction and the other hyperbilirubinemia linked to chronic rejection. After 3 cycles of coupled plasma filtration adsorption (CPFA), the bilirubin promptly decreased in both cases. CPFA is an extracorporeal therapy that uses plasma filtration associated with an adsorbent cartridge and hemofiltration to remove cytokines and inflammatory mediators associated with septic shock, severe sepsis, and multiple organ dysfunction syndrome. Each cycle of treatment lowered the bilirubin of our patients by ∼40%. CPFA deserves attention as a potential inexpensive short-lasting device to treat hyperbilirubinemia after liver surgery or transplantation. Moreover, the effects of CPFA should be further studied to address inflammatory mediators in chronic rejection after liver transplantation or other immunologic disorders.
高胆红素血症常伴随肝功能衰竭；因此，人工肝支持装置目前被用作通向更确定性治疗的桥梁，以清除水溶性和与白蛋白结合的毒素。我们报告了2例患者，其中1例在肝移植后出现早期移植物功能障碍，另1例出现与慢性排斥反应相关的高胆红素血症。经过3个周期的配对血浆滤过吸附（CPFA）治疗后，两例患者的胆红素均迅速下降。CPFA是一种体外治疗方法，它利用与吸附柱相关的血浆滤过和血液滤过来清除与感染性休克、严重脓毒症和多器官功能障碍综合征相关的细胞因子和炎症介质。每个治疗周期可使我们患者的胆红素降低约40%。CPFA作为一种潜在的廉价短期装置，在肝手术或移植后治疗高胆红素血症值得关注。此外，应进一步研究CPFA对肝移植后慢性排斥反应或其他免疫性疾病中炎症介质的影响。
