Chronic ambulatory liver support by membrane plasmapheresis with on-line detoxification.
Blood cellular elements and plasma protein losses are minimal for membrane plasmapheresis with on-line sorbent detoxification. Frequent (6/sk), chronic (3 mos), and long-term (8 hr) perfusions are possible for patients studied. It is recommended in deficiency states involving low protein, hypocoagulability or potential hormonal imbalances that aggressive medical management be applied. With regard to system performance, plasma filtration properties improved by the application of the closed plasma circuit and membranes with superior sieving and filtration properties. The effect of plasma solutes on filtration properties has been noted. In PBC patients the influence of total cholesterol concentration is particularly striking. Significant reduction of FFA and improvement of PMR were achieved in combination with bilirubin removal in liver failure patients, while bile acids (cholyglycine) levels were significantly reduced in 3 of PBC patients who expressed a subjective improvement of about 90% following 3 consecutive treatments. Four of 5 liver failure patients showed improved mental status with one patient surviving.