Use of artificial liver support.

Artificial liver support is used to remove toxic substances accumulating in the circulation of patients with fulminant hepatic failure. Charcoal haemoperfusion with infusion of prostacyclin (PGI2) to prevent platelet damage has become a routine treatment and has led to improved survival. In 76 patients treated 29 (38%) survived to leave hospital and of these 31 patients were treated when in Grade III coma and 20 (65%) survived. Charcoal haemoperfusion also reduced the incidence of cerebral oedema which is a major cause of death in fulminant hepatic failure. Most episodes (congruent to 80%) of cerebral oedema can be managed using the osmotic agent mannitol. In a complete liver support system both protein-bound and compounds of a middle relative molecular mass as well as water soluble compounds should be removed. An albumin-coated resin has been developed to remove these compounds and in preliminary clinical studies it has been shown to have good blood compatibility and satisfactory adsorption properties. The importance of combined systems has been confirmed in studies on the removal of inhibitors of brain Na+K+-ATPase, where both resin and charcoal columns removed significant amounts of the inhibitory activity.