Plasma Diafiltration Research Articles

Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Plasma Diafiltration

Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Plasma Diafiltration

Plasma exchange combining with plasma bilirubin adsorption effectively removes toxic substances and improves liver functions of hepatic failure patients.

Hepatic failure (HF) is a kind of complex disease characterizing with liver dysfunction and a few clinical complications. Artificial liver support system (ALSS) has been applied to HF patients to improve dysfunctional liver in recent years. This study aims to evaluate therapeutic effects of ALSS approaches, including plasma exchange (PE), plasma diafiltration (PDF) and plasma bilirubin adsorption (PBA), on liver function of HF patients. This study is a retrospective analysis involving 516 patients diagnosed as HF between February 2014 and February 2015. Patients were randomly divided into PE, PDF, PE plus PBA, and PDF plus PBA group. Meanwhile, single-drug group and combined-drug group were also divided. The liver functions, capability of removing toxic substances and coagulation functions were evaluated both pre-treatment and post-treatment. The side effects and hospital improvement rate were also observed post-treatment. Hospital improvement rate achieves to 69.6%. TBIL levels and MELD scores were significantly decreased post-treatment compared to pre-treatment (p<0.05). PTA values were significantly increased post-treatment compared to pre-treatment (p<0.05). Reduction value in PE+PBA group was significantly higher compared to PE and PDF group (p=0.002, 0.002, respectively). MELD scores were significantly decreased post-treatment compared to pre-treatment in each group (p<0.05). Combined-drug treatment is superior to single-drug treatment for removing toxic substances and improving liver functions. PE treatment, PDF treatment and PE+PBA treatment induced more side effects compared to PDF+PBA treatment. PE combining with PBA plays a better role in removing toxic substances, improving liver functions of HF patients.

PS-009 - Comparison of continuous plasma diafiltration therapy and conventional therapy in critical patients with acute liver failure

PS-009 - Comparison of continuous plasma diafiltration therapy and conventional therapy in critical patients with acute liver failure

Plasmadiafiltration ameliorating gut mucosal barrier dysfunction and improving survival in porcine sepsis models.

BackgroundThe object of this study is to explore whether the plasmadiafiltration (PDF) is more effective in improving the intestinal mucosal barrier function by removing more key large molecular inflammatory mediators and then prolonging the survival time.MethodsTotally, 24 porcine sepsis models induced by cecal ligation and puncture (CLP) operation were randomly divided into three groups: PDF group, high-volume hemofiltration (HVHF) group, and control group, and received 8 h treatment, respectively. The expression of ZO-1 and occludin in intestinal mucosal epithelial cells were detected by immunohistochemistry, and apoptotic protein caspase-3-positive lymphocytes were signed in mesenteric lymph nodes by TUNEL staining. The hemodynamic parameters were measured by invasive cavity detection. The tumor necrosis factor alpha (TNFα) and high-mobility group protein 1 (HMGB1) were tested by ELISA method. And then, the survival curves with all-cause death were compared with three groups.ResultsPDF led to a superior reversal of sepsis-related hemodynamic impairment and serum biochemistry abnormalities and resulted in longer survival time compared with HVHF and control (p < 0.01). Definitive protection from excessive TNF-α and HMGB1 response were only achieved by PDF. A more regular distribution pattern of ZO-1 and occludin along the epithelium was found in PDF animals (p < 0.01). The presence of apoptotic lymphocytes was significantly reduced in the PDF animals (p < 0.01).ConclusionsPDF can effectively eliminate more pivotal inflammatory mediators of TNFα and HMGB1 and reduce the inflammation damage of the intestinal mucosal barrier and apoptosis of lymphocyte then improve the circulation function and prolong the survival time.

Fulminant Liver Failure Due to Amanita Phalloides Toxicity Treated with Emergent Liver Transplantation

The clinical picture secondary to amanita phalloides, which began with gastrointestinal complaints, advanced to fulminant hepatic failure in two days. Emergency liver transplantation was decided for the case of a 48-year-old male patient, who at the same time had renal failure and acute pancreatitis. Bridge treatment with plasma diafiltration was applied until the liver transplantation, which was successfully performed on the fifth day of admission to the hospital. Acute pancreatitis and renal failure also resolved and the patient was discharged in a healthy condition on the 30th day of admission. The timing of the transplant in fulminant liver failure and criteria used to select the timing are particularly important. Transplantation should be performed not too early, nor too late. In addition, the development of multiple organ failure during the period until transplantation may result in the death of the patient. Therefore, extra corporeal liver support systems are suggested as an important treatment tool at this stage.

Efficacy of continuous plasma diafiltration therapy in critical patients with acute liver failure

Acute liver failure (ALF) is a critical illness with high mortality. Plasma diafiltration (PDF) is a blood purification therapy that is useful for ALF patients, but it is difficult to use when those patients have multiple organ failure or unstable hemodynamics. In these patients, symptoms are also likely to exacerbate immediately after PDF therapy. We developed continuous PDF (CPDF) as a new concept in PDF therapy, and assessed its efficacy and safety in ALF patients. Ten ALF patients (gender: M/F 6/4, Age: 47 ± 14) were employed CPDF therapy. The primary outcomes were altered liver function, measured by the model for end-stage liver disease (MELD) score, and total bilirubin and prothrombin time international normalized ratios (PT-INR), 5 days after CPDF therapy. Secondary outcomes included sequential organ failure assessment (SOFA) scores, 5 days after CPDF therapy, and the survival rate 14 days after this therapy. The MELD score (34.5-28.0; P = 0.005), total bilirubin (10.9-7.25 mg/dL; P = 0.048), PT-INR (1.89-1.31; P = 0.084), and SOFA score (10.0-7.5; P < 0.039) were improved 5 days after CPDF therapy. Nine patients were alive, and one patient died because of acute pancreatitis, complicated by ALF. There were no major adverse events related to this therapy under hemodynamic stability. In the present study, CPDF therapy safely supported liver function and generally improved the condition of critically ill patients with ALF.

Successful Treatment of Enterohemorrhagic Escherichia coli O111‐Induced Acute Encephalopathy and Hemolytic‐Uremic Syndrome With Plasma Diafiltration

Successful Treatment of Enterohemorrhagic <i>Escherichia coli</i> <scp>O</scp>111‐Induced Acute Encephalopathy and Hemolytic‐Uremic Syndrome With Plasma Diafiltration

Efficacy of continuous plasma diafiltration therapy

Acute liver failure (ALF) is a critical illness with high mortality. Plasma diafiltration (PDF) is a blood purification therapy in which simple plasma exchange is performed using a selective membrane plasma separator while the dialysate flows outside the hollow fibers. While several studies demonstrated that PDF therapy is a useful blood purification therapy for patients with ALF, PDF therapy is often difficult to employ in ALF patients complicated with multiple organ failure, especially in those with unstable hemodynamics. Furthermore, it is likely to re-occur immediately after PDF therapy. We developed continuous PDF (CPDF) as a new concept in PDF therapy, and assessed its efficacy and safety in ALF patients compared with conventional plasma exchange (PE) plus continuous hemodiafiltration (CHDF) therapy in this study.

Plasma filtration with dialysis (plasma diafiltration) in critically ill patients with acute liver failure

Removing the middle molecular weight substances including cytokines and albumin-bound toxin could be effective for patients with acute liver failure (ALF). We have developed a new system, plasma filtration with dialysis (plasma diafiltration (PDF)) [1],[2], and assessed its efficacy in multicenter analysis.

Abstract 349: Effects of Continuous Plasma Diafiltration Therapy in Septic Shock With Acute Liver Failure

Background: Plasma diafiltration (PDF) is blood purification therapy in which simple plasma exchange is performed using a selective membrane plasma separator while the dialysate flows outside the hollow fibers. Several studies demonstrated that PDF therapy is one of the most useful blood purification therapies for use in cases of acute liver failure or severe sepsis. However, PDF therapy is very difficult to undergo in septic shock patients with acute liver failure because of unstable hemodynamics. Moreover, it is likely to deteriorate in acute liver failure immediately after PDF therapy. We have experienced that continuous PDF (CPDF) therapy can undergo in unstable patients with acute liver failure. Therefore, we evaluated the effects of CPDF therapy in septic shock patients with acute liver failure. Hypothesis: We hypothesis that CPDF therapy has beneficial effects for septic shock patients with acute liver failure. Methods: Nine patients (M/F 7/2, mean age 55 years) with septic shock, who combined acute liver failure, renal failure and respiratory failure, underwent CPDF therapy. The CPDF therapy was undergone for 7 days. Primary outcomes were changes in hemodynamics and inflammatory responses after CPDF therapy, and secondary outcomes were changes in liver functions and SOFA scores at 7 days after therapy and survival rate at 14days after therapy. Results: In primary outcomes, hemodynamics in all patients improved at one day after CPDF therapy. WBC counts improved (22,634 to 9,893; p&lt;0.05), C-reactive protein levels decreased (11.0 to 2.0 mg/dL; p&lt;0.05), and procalcitonin levels decreased (31.6 to 2.9 ng/mL; p&lt;0.05) at 7days after CPDF therapy. In secondary outcomes, total bilirubin decreased (8.3 to 3.4 mg/dL; p&lt;0.05) and PT-INR did not decreased (1.22 to 1.19) at 7 days after CPDF therapy. SOFA scores decreased (13.0 to 8.0; p&lt;0.05) at 7 days after CPDF therapy. All patients recovered and discharged in ICU. Conclusion: In the present study, CPDF therapy significant improved hemodynamics, inflammatory responses and severity in septic shock patients with acute liver failure.

A Case of Living Donor Liver Transplant Recipient Treated With Novel Blood Purification “Plasma Diafiltration”

Blood purification therapy is indispensable for liver transplant recipients. The case of a living donor liver transplant recipient who represented graft insufficiency and was supported by novel blood purification "plasma diafiltration" immediately after operation is presented. A 60-year-old woman was referred for living donor liver transplant because of liver cirrhosis due to hepatitis C. Elective living donor liver transplant was performed, but the graft was small for size. Thus, the signs of graft insufficiency appeared immediately after the operation, and plasma diafiltration was used as a bridge to graft regeneration. After plasma diafiltration was started, the recipient recovered promptly, and withdrawal was performed 35 hours after induction without any complications. Plasma diafiltration is a useful and safe liver support for liver transplant recipients, including immediately after liver transplantation.

Plasma Diafiltration Therapy in Patients With Postoperative Liver Failure

Plasma diafiltration (PDF) is a blood purification therapy in which simple plasma exchange (PE) is performed using a selective membrane plasma separator while the dialysate flows outside of the hollow fibers. A prospective, multicenter study was undertaken to evaluate the changes in biochemical examination of blood and the 28-day and 90-day survival rates of patients with postoperative liver failure (PLF). Eleven patients with PLF were studied with the therapy performed 98 times. The Model for End-Stage Liver Disease (MELD) score was categorized into three grades: 20-29, 30-39, and 40 or higher. The survival rate was assessed by the severity of MELD score. The 28-day survival rate was 45.5% and that at 90 days was 27.3%. The levels of total bilirubin, BUN, and creatinine decreased significantly after treatment. On the other hand, the levels of total protein increased after treatment and those of albumin did not change significantly. PDF may be the useful blood purification therapies for use in cases of PLF in terms of medical economics and the removal of water-soluble and albumin-bound toxins.

Multicenter Study of Plasma Diafiltration in Patients With Acute Liver Failure

Plasma diafiltration (PDF) is a blood purification therapy in which simple plasma exchange (PE) is performed using a selective membrane plasma separator while the dialysate flows outside the hollow fibers. A prospective, multicenter study was undertaken to evaluate the changes in bilirubin, IL-18, and cystatin C, as well as the 28-day and 90-day survival rates, with the use of PDF according to the level of severity as measured by the Model for End-Stage Liver Disease (MELD) score. Twenty-one patients with liver failure were studied: 10 patients had fulminant hepatitis and PDF therapies were performed 28 times; 11 had acute liver failure with the therapy performed 96 times. Levels of total bilirubin, IL-18, and cystatin C decreased significantly after treatment. The 28-day survival rate was 70.0% and that at 90 days was 16.7%. According to the severity of the MELD score, each of the results compared well with the use of Molecular Adsorbent Recirculating System or Prometheus therapy. In conclusion, PDF appears to be one of the most useful blood purification therapies for use in cases of acute liver failure in terms of medical economics and the removal of water-soluble and albumin-bound toxins.

12 Efficacy of plasma filtration with dialysis (plasma dia-filtration) for the patients with septic multiple organ failure including hyperbilirubinemia

12 Efficacy of plasma filtration with dialysis (plasma dia-filtration) for the patients with septic multiple organ failure including hyperbilirubinemia

Efficacy of Cytokine Removal by Plasmadiafiltration Using a Selective Plasma Separator: In Vitro Sepsis Model

More effective removal of pro- and anti-inflammatory cytokines may play an important role in the treatment of sepsis. Plasmadiafiltration (PDF) with a larger selective plasma separator was performed to study the cytokine and plasma protein permeability profiles of the membrane in an in vitro sepsis model. The in vitro sepsis model was constructed by exposure of human whole blood to bacterial lipopolysaccharide. EVACURE 2A, a selective plasma separator, was placed in the blood circuit of PDF. Sieving coefficients of cytokines and plasma protein were tested in post-dilution PDF mode at the following operating parameters: blood flow rate 150 mL/min; dialysate flow rate 33.33 mL/min; replacing fluid flow rate 6.67 mL/min; ultrafiltration rate 5 mL/min. An enzyme linked immunoadsorbent assay was used to measure the concentrations of tumor necrosis factor-α (TNF-α), high-mobility group box 1 protein (HMGB1), interleukin-1β (IL-1β), interleukin-1 receptor antagonist (IL-1ra), interleukin-2 (IL-2), interleukin-2 receptor (IL-2r), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) in plasma and ultrafiltrate. Sieving coefficients of different solutes ranged from 0.1 to 1.0 at first, decreased 10%-60% after 1 h of PDF, and then remained stable. Total clearance rates of cytokines ranged from 15 to 80 mL/min. The concentrations of cytokines decreased 20-80% after 1 hour of PDF. The sieving coefficient of albumin was 0.1 at first and then decreased to 0.05 after 1 hour of therapy. Plasmadiafiltration with Evacure 2A plasma separator can effectively remove almost all of the inflammatory mediators with low albumin loss.

Treatment of patients with liver failure using fractional plasma diafiltration: an analysis of 56 cases

Treatment of patients with liver failure using fractional plasma diafiltration: an analysis of 56 cases

A Case Report of Pediatric Fulminant Hepatitis Treated With Plasma Diafiltration

Plasma diafiltration (PDF) is blood purification therapy in which simple plasma exchange is performed with a membrane plasma separator while dialysate flows outside the hollow fibers. A 14-year-old boy with fulminant hepatitis underwent two sessions of PDF and one session of hemodiafiltration. We infused filtered replacement fluid for artificial kidneys at a dialysate flow rate of 600 mL/h and a replacement flow rate of 450 mL/h. We infused fresh frozen plasma (1200 mL) and 25% albumin solution (50 mL) intravenously over 8 h. Each PDF session lasted 8 h. The patient's total bilirubin, interleukin-18, and cystatin C levels decreased with treatment, and he recovered from hepatic failure. PDF may be an extremely useful blood purification therapy for pediatric fulminant hepatitis in terms of both medical economics and cytokine removal.

A Case Report of Hepatorenal Syndrome Treated With Plasma Diafiltration (Selective Plasma Filtration with Dialysis)

Plasma diafiltration (PDF) (selective plasma filtration with dialysis) is blood purification therapy in which simple plasma exchange is performed using a membrane plasma separator (Evacure EC-2A) while dialysate flows outside of the hollow-fibers. A 74-year old man with hepatorenal syndrome underwent four sessions of PDF and three sessions of HDF. Finally he recovered from hepatorenal syndrome. In this therapy, the levels of total bilirubin, interleukin-18, creatinine, and cystatin C were significantly reduced. On the other hand, there were no significant differences in the total protein and albumin levels before and after PDF. PDF may be one of the most useful blood purification therapies for hepatorenal syndrome in terms of medical economics.