Journal List > J Korean Soc Transplant > v.23(3) > 1034296

J Korean Soc Transplant. 2009 Dec;23(3):244-251. Korean.
Published online December 31, 2009.  https://doi.org/10.4285/jkstn.2009.23.3.244
Copyright © 2009 The Korean Society for Transplantation
Effectiveness of Plasmapheresis as a Liver Support for Graft Dysfunction Following Adult Living Donor Liver Transplantation
Shin Hwang, M.D.,1 Seog-Woon Kwon, M.D.,2 Gil-Chun Park, M.D.,1 Young-Dong Yu, M.D.,1 Kwan-Woo Kim, M.D.,1 Nam-Kyu Choi, M.D.,1 Young-Il Choi, M.D.,1 Pyung-Jae Park, M.D.,1 Geum Borae Park, M.D.,2 Dong-Hwan Jung, M.D.,1 Gi-Won Song, M.D.,1 Deok-Bog Moon, M.D.,1 Chul-Soo Ahn, M.D.,1 Ki-Hun Kim, M.D.,1 Tae-Yong Ha, M.D.,1 YuSun Min, R.N.,2 Suk-Kyung Hong, M.D.,3 Kyu-Hyouck Kyoung, M.D.,3 Jeong-Ik Park, M.D.,4 and Sung-Gyu Lee, M.D.1
1Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
2Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
3Department of Surgery, Division of General Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
4Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Corresponding author (Email: sglee2@amc.seoul.kr )
Received August 20, 2009; Accepted October 22, 2009.

Abstract

Background

Severe graft dysfunction has been occasionally encountered following adult living donor liver transplantation (LDLT). This study intended to assess the effectiveness of plasmapheresis (PP) as a liver supportive measure in LDLT recipients showing severe graft dysfunction.

Methods

During 1 year of 2007, 276 adult LDLTs were performed in our institution. Of them 27 underwent PP therapy as a liver support.

Results

Seventeen underwent PP during the first month following LDLT and another 10 underwent PP after that period. The underlying causes of such liver support were acute and chronic rejections, ischemic damage, viral hepatitis recurrence and unknown causes. A total of 329 sessions of PP were performed for these 27 patients, indicating 12.2±9.9 times per patient for 28.1±32.2 days. Concurrent hemodiafiltration was done in 66.7%. Serum total bilirubin level was significantly reduced following PP therapy: 23.2±6.5 mg/dL before PP and 14.4±5.6 mg/dL at 1 week after completion of PP (P<0.001). Other biochemical parameters did not significantly affected by PP. Overall 1-year patient survival rate was 63.0%. Six-month graft survival rate after completion of PP was 82.6% in 17 patients undergoing PP during the first posttransplant month and 30% in 10 patients undergoing PP after 1 month (P= 0.013).

Conclusions

The results of this study implicate that PP has a beneficial effect on the recovery of liver graft function, especially during the early posttransplant period. We suggest to perform active application of PP therapy for liver recipients showing severe graft dysfunction of total bilirubin greater than 15~20 mg/dL.

Keywords: Living donor liver transplantation; Graft dysfunction; Plasmapheresis

Figures


Fig. 1
Number of plasmapheresis sessions per one recipient undergone living donor liver transplantation.
Click for larger image


Fig. 2
Overall patient survival curve of 27 adult living donor liver transplant recipients undergoing plasmapheresis for liver support.
Click for larger image

Tables


Table 1
Comparison of the biochemical profiles in 27 adult living donor liver transplant recipients undergoing plasmapheresis (PP) for liver support
Click for larger image

References
1. Naruse K, Nagashima H, Sakai Y, Kokudo N, Makuuchi M. Development and perspectives of perfusion treatment for liver failure. Surg Today 2005;35:507–517.
2. Chiu A, Chan LM, Fan ST. Molecular adsorbent recirculating system treatment for patients with liver failure: the Hong Kong experience. Liver Int 2006;26:695–702.
3. Gaspari R, Avolio AW, Zileri Dal Verme L, Agnes S, Proietti R, Castagneto M, et al. Molecular adsorbent recirculating system in liver transplantation: safety and efficacy. Transplant Proc 2006;38:3544–3551.
4. Ozdemir FN, Tutal E, Sezer S, Gür G, Bilgic A, Haberal M. Effect of supportive extracorporeal treatment in liver transplantation recipients and advanced liver failure patients. Hemodial Int 2006;10 S2:28–32.
5. Lee SG, Hwang S, Kim KH, Ahn CS, Moon DB, Ha TY, et al. Toward 300 liver transplants a year. Surg Today 2009;39:367–373.
6. Schmidt LE, Wang LP, Hansen BA, Larsen FS. Systemic hemodynamic effects of treatment with the molecular adsorbents recirculating system in patients with hyperacute liver failure: a prospective controlled trial. Liver Transpl 2003;9:290–297.
7. Hetz H, Faybik P, Berlakovich G, Baker A, Bacher A, Burghuber C, et al. Molecular adsorbent recirculating system in patients with early allograft dysfunction after liver transplantation: a pilot study. Liver Transpl 2006;12:1357–1364.
8. Kellersmann R, Gassel HJ, Bühler C, Thiede A, Timmermann W. Application of Molecular Adsorbent Recirculating System in patients with severe liver failure after hepatic resection or transplantation: initial single-centre experiences. Liver 2002;22 S2:56–58.
9. Steiner C, Mitzner S. Experiences with MARS liver support therapy in liver failure: analysis of 176 patients of the International MARS Registry. Liver 2002;22 S2:20–25.
10. Gaspari R, Cavaliere F, Sollazzi L, Perilli V, Melchionda I, Agnes S, et al. Molecular adsorbent recirculating system (Mars) in patients with primary nonfunction and other causes of graft dysfunction after liver transplantation in the era of extended criteria donor organs. Transplant Proc 2009;41:253–258.
11. Novelli G, Rossi M, Pretagostini M, Pugliese F, Ruberto F, Novelli L, et al. One hundred sixteen cases of acute liver failure treated with MARS. Transplant Proc 2005;37:2557–2559.
12. Akdogan M, Camci C, Gurakar A, Gilcher R, Alamian S, Wright H, et al. The effect of total plasma exchange on fulminant hepatic failure. J Clin Apher 2006;21:96–99.
13. Bektas M, Idilman R, Soykan I, Soydan E, Arat M, Cinar K, et al. Adjuvant therapeutic plasma exchange in liver failure: assessments of clinical and laboratory parameters. J Clin Gastroenterol 2008;42:517–521.
14. Hwang S, Ha TY, Ahn CS, Kim KH, Lee SG. Reappraisal of plasmapheresis as a supportive measure in a patient with hepatic failure after major hepatectomy. Case Rep Gastroenterol 2007;1:162–167.
15. Buckner CD, Clift RA, Volwiler W, Donohue DM, Burnell JM, Saunders FC, et al. Plasma exchange in pa tients with fulminant hepatic failure. Arch Intern Med 1973;132:487–492.
16. Mandal AK, King KE, Humphreys SL, Maley WR, Burdick JF, Klein AS. Plasmapheresis: an effective therapy for primary allograft nonfunction after liver transplantation. Transplantation 2000;70:216–220.
17. Morimoto T, Matsushima M, Sowa N, Ide K, Sawanishi K. Plasma adsorption using bilirubin-adsorbent materials as a treatment for patients with hepatic failure. Artif Organs 1989;13:447–452.
18. Singer AL, Olthoff KM, Kim H, Rand E, Zamir G, Shaked A. Role of plasmapheresis in the management of acute hepatic failure in children. Ann Surg 2001;234:418–424.
19. Camci C, Akdogan M, Gurakar A, Gilcher R, Rose J, Monlux R, et al. The impact of total plasma exchange on early allograft dysfunction. Transplant Proc 2004;36:2567–2569.
20. Hwang S, Lee SG, Jung DH, Kim KH, Ha TY, Song GW. Simulation of deceased-donor liver graft allocation as UNOS status I or IIa on the current Korean setting for patients with hepatitis B virus-induced fulminant hepatic failure. Korean J Hepatobiliary Pancreat Surg 2009;13:31–36.
21. Yamamoto R, Nagasawa Y, Marubashi S, Furumatsu Y, Iwatani H, Iio K, et al. Early plasma exchange for progressive liver failure in recipients of adult-to-adult living-related liver transplants. Blood Purif 2009;28:40–46.
22. Bektas M, Idilman R, Soykan I, Soydan E, Arat M, Cinar K, et al. Adjuvant therapeutic plasma exchange in liver failure: assessments of clinical and laboratory parameters. J Clin Gastroenterol 2008;42:517–521.
23. Gui D, Spada PL, de Gaetano A, Pacelli F. Hypocholesterolemia and risk of death in the critically ill surgical patient. Intensive Care Med 1996;22:790–794.
24. Giovannini I, Boldrini G, Chiarla C, Giuliante F, Vellone M, Nuzzo G. Pathophysiologic correlates of hypocholesterolemia in critically ill surgical patients. Intensive Care Med 1999;25:748–751.
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