Continuous Flow Membrane Plasmapheresis Utilizing Cellulose Acetate Hollow Fiber in Hepatic Failure

Abstract

The major problems of treatment using hepatic assist devices such as hemoperfusion through charcoal and hemodialysis or hemofiltration with high-permeability membrane include: (Castino et al. 1976) removal of protein-bound toxins is insufficient, (Chirito et al. 1979) the devices cannot be continuously used for the clinically required period, and (Ito et al. 1975) supplementation of defects of the liver’s synthetic functions is insufficient. Plasma exchange with plasmapheresis, which was introduced into treatment of patients with acute hepatic failure by Lepore and Martel (1967) is advantageous in that it not only removes protein-bound toxins but also provides essential nutrients normally supplied by the liver. Unlike exchange transfusion of whole blood, it does not cause hematological problems and for that reason it appears a rational treatment modality for acute hepatic failure. Due to lack of techniques for effective plasma separation, however, it has not been widely used. Therefore its clinical effectiveness in hepatic failure has not been completely confirmed. In recent years, a technique for obtaining large amounts of platelet-free plasma during extracorporeal circulation has been developed by Ito et al. (1975), Castino et al. (1976) and Yamazaki et al. (1977). Therapeutic plasmapheresis with plasma exchange using these techniques in various diseases, including hepatic failure, is now being reviewed.