Exchange transfusion in the treatment of patients with acute hepatitis in coma

Abstract

Acute hepatic necrosis with profound coma carries an ominous prognosis. Conventional therapy has had little influence on recovery. Various new therapeutic modalities are currently being tried. Survival figures derived by compiling reports on exchange transfusion are somewhat encouraging when the data are compared to the salvage rate in patients with fulminant hepatitis treated conventionally, even after the addition of steroids. Current knowledge is lacking as to the specific lethal factor (s) and/or mechanism (s) that are operating in these patients. Pathogenetic ignorance notwithstanding, the remarkable regenerative power of the liver dictates that all efforts be made to sustain life, as the therapist hopefully awaits recovery. If facilities and personnel are available, we feel exchange transfusion should be considered when 24 hr of intensive conventional therapy, including high doses of steroids, fails to bring about significant improvement. Any decision on duration of therapy in the absence of neurologic improvement remains arbitrary. Histologic evidence of liver cell regeneration, if it can be obtained, may justify continued therapeutic efforts. Exchange transfusion must be evaluated by a cooperative controlled study before its therapeutic value can be established.