Plasma Adsorption Perfusion (BR-350) Versus Open Albumin Dialysis (OPAL) for Hyperbilirubinemia in Hepatic Failure in Cirrhotic Patients.

BACKGROUND

In the last decades, various extracorporeal liver support systems were developed for hepatic failure with hyperbilirubinemia with the aim to clear the blood from protein-bound toxic molecules. Open albumin dialysis (OPAL) is a complex and expensive system that requires addition of human albumin. Plasma adsorption perfusion (PAP) using the anion exchange resin adsorber, BR-350, is an alternative liver support method that does not need additional blood products and is more cost-effective and less time-consuming.

METHODS

At the University Hospital Essen, PAP using BR-350 was performed in a cohort of 9 patients with a mean of 6 sessions per patient. In a retrospective analysis, we compared the detoxification ability of PAP with that of the OPAL system conducted among 24 patients and with standard medical treatment (SMT) including hemodialysis that was performed among 24 patients. In addition, the technical effectiveness of a single session of PAP with BR-350 was compared with OPAL among 12 patients who were treated with both methods in a crossover design.

RESULTS

The first single session (30.7.3 ± 13.5 mg/dL to 25.8 ± 13.4 mg/dL, p = 0.02) and the complete therapy (30.7 ± 13.5 mg/dL to 16.2 ± 6.3 mg/dL, p = 0.004) with PAP using BR-350 resulted in a statistically significant decrease of bilirubin concentrations. The median relative reduction of bilirubin achieved at the end of liver support treatment was comparable between PAP and OPAL (47% vs. 40%, p = 0.29). PAP was associated with a higher bilirubin reduction than the SMT plus dialysis (47% vs. -30%, p = 0.0001). The crossover comparison between the single session of PAP using BR-350 and OPAL revealed similar mean relative reduction rates of bilirubin (11% vs. 10%, p = 0.81). The single session of OPAL was associated with a more pronounced decrease of alkaline phosphatase, gamma-glutamyltransferase, hemoglobin, platelets, and leucocytes compared to PAP.

CONCLUSIONS

Both studied methods had comparable efficacy in reducing bilirubin in our studied patients in contrast to the retrospective control group. Since other substrates may also be relevant in treating liver failure, more studies are required. Patients with concomitant renal failure benefit from OPAL, whereas PAP might be more eligible for patients with a high risk of bleeding.