Treatment of acute hepatic failure by hemoperfusion over baboon and human livers: alphafetoprotein levels in serum.

Twelve patients with acute liver failure, two patients with cirrhotic failure of the liver, and one patient in the terminal stage of cirrhotic liver were treated. The patients had grade IV or V hepatic coma. Twenty-seven perfusions were carried out, each lasting 8 to 27 hours, with one to four perfusions per patient. Eight patients with acute liver failure were brought out of the coma. Six of them showed sufficient clinical symptoms of hepatic regeneration; five of these could be discharged. These results suggest that 50% of complete clinical recovery of consciousness from grade IV or V coma in acute hepatic failure is possible with this therapy. The three patients with liver cirrhosis treated with a total of five hemoperfusions did awaken, but died because of insufficient hepatic regeneration. The serum alphafetoprotein (AFP) levels were examined. In those patients brought out of the coma, a rapid increase of AFP up to 260--500 ng/ml was observed. These levels remained high for several weeks in the patients who survived. In the patients who died of liver insufficiency, AFP levels increased only slightly or briefly, so AFP could be a good criterion for determining the prognosis for coma patients with this treatment.