Authors:Ágnes Bakos, Csaba Rikker, Szilveszter Tóvárosi, and †Mihály Kárteszi
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.
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
, respectively, that could not be controlled by conservative therapy.
Ten treatments were performed in the three female patients. No serious complication was observed. Significant reduction of albumin-bound toxins (unconjugated bilirubin
= 0.048; bile acid
= 0.001) and water-soluble toxins (conjugated bilirubin
= 0.002; creatinine
= 0.007) was observed. Ammonia, urea, fibrinogen and antithrombin III levels showed no significant change. All three patients recovered without liver transplantation.
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.