Extra-corporeal non-liver transplant therapies for acute liver failure: Focus on plasma exchange and continuous renal replacement therapy.

Autor: Zachariah U; Department of Hepatology, Christian Medical College, Vellore, 632 004, India., Vijayalekshmi B; Wellcome Trust Research Laboratories, Division of GI Sciences, Christian Medical College, Vellore, 632 004, India., Matthai SM; Department of Pathology, Central Electron Microscopy Facility, Christian Medical College, Vellore, 632 004, India., Goel A; Department of Hepatology, Christian Medical College, Vellore, 632 004, India., Eapen CE; Department of Hepatology, Christian Medical College, Vellore, 632 004, India. eapen@cmcvellore.ac.in.
Jazyk: angličtina
Zdroj: Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology [Indian J Gastroenterol] 2024 Apr; Vol. 43 (2), pp. 338-348. Date of Electronic Publication: 2024 Mar 26.
DOI: 10.1007/s12664-024-01558-6
Abstrakt: The acute inflammatory milieu in patients with acute liver failure (ALF) results in 'toxic' blood in these patients. In vitro experiments have shown that the plasma obtained from ALF patients is toxic to rabbit hepatocytes and inhibits regeneration of rat hepatocytes. Treatments such as plasma exchange and continuous renal replacement therapy to cleanse the blood have improved survival in ALF patients. In the liver microcirculation, the exchange of fluid across fenestrae in liver sinusoidal endothelial cells (LSECs) is vital for proper functioning of hepatocytes. Clogging of the liver filter bed by inflammatory debris and cells ('traffic jam hypothesis') impeding blood flow in sinusoids may in turn reduce the exchange of fluid across LSEC fenestrae and cause dysfunction and necrosis of hepatocytes in ALF patients. In mouse model of paracetamol overdose, disturbances in microcirculation in the liver preceded the development of injury and necrosis of hepatocytes. This may represent a reversible pathophysiological mechanism in ALF which may be improved by the anti-inflammatory effect of plasma exchange. Wider access to urgent plasma exchange is a major advantage compared to urgent liver transplantation to treat ALF patients worldwide, especially so in resource constrained settings. Continuous hemo-filtration or dialysis is used to reduce ammonia levels and treat cerebral edema in ALF patients. In this review, we discuss the different modalities to cleanse the blood in ALF patients, with an emphasis on plasma exchange, from a hepatology perspective.
(© 2024. Indian Society of Gastroenterology.)
Databáze: MEDLINE
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