%0 Journal Article
%T Treatment of hepatic encephalopathy by on-line hemodiafiltration: a case series study
%A Shinju Arata
%A Katsuaki Tanaka
%A Kazuhisa Takayama
%A Yoshihiro Moriwaki
%A Noriyuki Suzuki
%A Mitsugi Sugiyama
%A Kazuo Aoyagi
%J BMC Emergency Medicine
%D 2010
%I BioMed Central
%R 10.1186/1471-227x-10-10
%X This case series study was conducted from May 2001 to October 2008 at the medical intensive care unit of a tertiary care academic medical center. Seventeen consecutive patients who admitted to our hospital presenting with acute liver failure were treated with artificial liver support including daily on-line hemodiafiltration and plasma exchange.After 4.9 ¡À 0.7 (mean ¡À SD) on-line hemodiafiltration sessions, 16 of 17 (94.1%) patients completely recovered from hepatic encephalopathy and maintained consciousness for 16.4 ¡À 3.4 (7-55) days until discontinuation of artificial liver support (a total of 14.4 ¡À 2.6 [6-47] on-line hemodiafiltration sessions). Significant correlation was observed between the degree of encephalopathy and number of sessions of on-line HDF required for recovery of consciousness. Of the 16 patients who recovered consciousness, 7 fully recovered and returned to society with no cognitive sequelae, 3 died of complications of acute liver failure except brain edema, and the remaining 6 were candidates for liver transplantation; 2 of them received living-related liver transplantation but 4 died without transplantation after discontinuation of therapy.On-line hemodiafiltration was effective in patients with acute liver failure, and consciousness was maintained for the duration of artificial liver support, even in those in whom it was considered that hepatic function was completely abolished.Acute liver failure is usually fatal, and in the US, the mortality rate remains as high as 30% in adult patients [1]. Although liver transplantation for acute liver failure has increased the survival rate markedly, the limited supply of suitable livers implies that transplantation is not available to all patients; 22.7% of patients who were listed for transplantation die awaiting transplantation 3 days after being listed (range 1-6 days). On the other hand, 45% of patients with acute liver failure survive with medical therapy alone without liver transplantation [1].
%U http://www.biomedcentral.com/1471-227X/10/10