Plasma separation and bilirubin adsorption for excessive hyperbilirubinemia before and after liver transplantation

Severe hyperbilirubinemia is known to exert multiple toxic effects, but there are very little tools against the bilirubin intoxication. Plasma separation and bilirubin adsorption by an anion-exchange adsorbent column (BR-350) were performed in 13 patients with severe jaundice and multiple organ failure developed either before or after orthotopic liver transplantation. Forty-four sessions were performed and in 30% of them the plasma procedure was combined with hemodialysis treatment.

Three to four liters of plasma were separated by membrane plasma separation, then perfused to a rate of 20–30 ml/min through an anion exchange adsorbent and returned to the venous blood line of the plasma separator.

The bilirubin removal rate for total bilirubin was 24.8 ± 12.9% for conjugated bilirubin and 25.2 ± 14% for the non-conjugated form. The final values of plasma bilirubin were directly related to the initial ones (r = 0.824, P < 0001). The mean adsorption rates on the BR-350 column were 72.6% in the first 30 min and 39% after perfusion of 500 and 1000 ml of plasma respectively. A rebound in the bilirubin levels was present from the very first minutes after the end of the procedure; 24 hours later the rebound recorded in 18 treatment was 34.9 ± 38.7% compared to the end of the treatment.

In patients undergoing four or more repeated sessions of plasma separation and bilirubin adsorption, the level of seric bilirubin decreased from 57 ± 12 to 17 ± 10 mg/dl.

In conclusion, extracorporeal anion exchange plasma perfusion/ bilirubin adsorption is a safe and effective treatment and it should be considered as a supportive therapy for excessive hyperbilirubimenic side effects in cholestatic disorders.