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Despite intensive therapy, the mortality of acute hepatic failure is 60 to 90% without liver transplantation. Due to the limited number of transplantable organs, however, a significant percentage of patients die while on the waiting list. In order to reduce mortality, several attempts have been made to remove the albumin-bound and water-soluble toxic substances accumulated in hepatic failure, aimed at supporting spontaneous regeneration of the liver and maintaining patients alive until liver transplantation. Prometheus® treatment is a relatively new technique combining Fractionated Plasma Separation and Adsorption (FPSA) with high-flux dialysis. During the procedure the patient’s own separated albumin-rich plasma flows through special adsorbers, allowing elimination of toxins bound to albumin, while the water-soluble toxins are removed by haemodialysis. Objective: The authors’ intention was to demonstrate the efficacy of Prometheus® treatment in patients with acute hepatic failure due to intoxication. Patients and Method: Prometheus® treatment was administered in three patients with acute hepatic failure due to severe intoxication caused by paracetamol, potassium permanganate and Amanita phalloides , respectively, that could not be controlled by conservative therapy. Results: Ten treatments were performed in the three female patients. No serious complication was observed. Significant reduction of albumin-bound toxins (unconjugated bilirubin p = 0.048; bile acid p = 0.001) and water-soluble toxins (conjugated bilirubin p = 0.002; creatinine p = 0.007) was observed. Ammonia, urea, fibrinogen and antithrombin III levels showed no significant change. All three patients recovered without liver transplantation. Conclusion: Toxins accumulated in acute hepatic failure can be removed efficiently by Prometheus® treatment. The procedure is safe. In cases not controllable by conservative therapy it allows patients survive until their liver regenerates spontaneously or liver transplantation becomes feasible.

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acute hepatic failure and chronic cirrhosis with ascites. Artif. Organs, 1994, 18 , 355–362. Ash S. R. Hemodiabsorption in treatment of acute hepatic failure and chronic cirrhosis

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. Riely CA ( 2010 ): Acute hepatic failure in late pregnancy . Cited 2010 December 22 (online). Retrieved from www1.easl.ch/PGC/C.%20Riely.pdf 4

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