Volume 3 Supplement 1
High-volume continuous veno-venous haemofiltration in hyper-acute liver failure: a pilot study
© Current Science Ltd 1999
Published: 16 March 2000
Once defined clinical criteria are fulfilled in hyper-acute liver failure (ALF) mortality without liver transplantation (OLT) approaches 90%. Patients clinical condition may deteriorate whilst awaiting a graft, such that transplantation becomes impossible due to the rapid progression of multiple organ failure. There is need for therapies that may stabilise the patient and thus provide a 'bridge to transplantation'. Animal studies suggest that high-volume continuous veno-venous haemofiltration (HVF) in septic shock is associated with improvements in haemodynamic stability and a reduction in the requirement for vasopressor support. We report findings of a pilot study of HVF in patients with ALF.
Patients and methods
Eight patients fulfilling transplantation criteria with acetaminophen induced ALF were studied. Median age was 28 years (range 19–51), INR 4.6 (1.9–15), pH 7.23 (7.1–7.42), lactate 9.4 mmol/l (6.7–17) and APACHE II 24 (22–34). Six patients (75%) were receiving vasopressor support with noradrenaline at 0.29 μg/kg/min (0.03–0.5) and all were in anuric renal failure. Five patients were already established on conventional veno-venous filtration. HVF (Baxter system) was commenced 2 days (1–4) after admission using buffer-free dialysate at 4000 ml/h (3500–6000) with concurrent NaHCO3 infusion and filter surface area 1.25 m2 for a median of 34 h (22–72).
HVF effectively corrects acidosis in patients with ALF and is associated with improvements in haemodynamic stability. Its use in the support of patients awaiting transplantation deserves further investigation.