Removal of Bile Acids by Various Means of Artificial Liver Support

Abstract

Bile acid removal from plasma is one criterion by which artificial liver support systems may be judged. In vitro adsorption studies were performed using Amberlite XAD resins. Amberlite XAD-4 showed strongest bile acid binding, particularly of conjugated bile acids, which predominate in acute liver failure. Various artificial liver support systems were applied to the treatment of patients suffering from fulminant hepatic failure, including haemoperfusion over polyhema-coated activated charcoal and over albumin-coated Amberlite XAD-7, plasma perfusion (after cell separation) over uncoated Amberlite XAD-4 and XAD-7, and extracorporeal baboon liver perfusion. A low bile acid clearance (〈 15 ml/min) was found for coated sorbents, while the uncoated resins Amberlite XAD-4 and XAD-7 allowed a mean bile acid clearance of 45–50 ml/min during 4 h of perfusion. Extracorporeal baboon liver perfusion could be carried out for 60 h at a mean bile acid clearance of 22 ml/min, which resulted in a clearance of 80 liters of the patient’s plasma during one perfusion procedure.