EBM時代の人工肝補助療法

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Fulminant hepatic failure (FHF) is a fatal disease that results from severe impairment of liver function. Two major symptoms of FHF are coma and severe coagulopathy due to massive hepatic damage. Artificial liver support (ALS) should be used in patients with these two symptoms until their liver regenerates and regains normal function. However, in cases where the liver cannot regenerate or is progressively deteriorating, ALS may be used to compensate for damaged liver function prior to liver transplantation and until the donor liver is working. The ALS system has been in use for 50 years. Recently, in Japan, the use of plasma exchange in combination with hemodiafiltration has resulted in over 90% of comatose patients with FHF regaining consciousness and has sustained patients who had fallen into an ahepatic state. Conversely, a recent Cochrane Hepatobiliary Group meta-analysis on the efficacy of ALS for FHF has suggested that there is no ALS system that is effective in the improvement of survival. However, this report excluded Japanese reports because publications from Japan are not of randomized control trials. Using the awakening rate of comatose patients as a primary endpoint of ALS treatment is more appropriate than survival rate because ALS is a symptomatic treatment. Therefore, we should undertake new clinical trials using more appropriate endpoints and study designs to provide strong evidence of the benefits of ALS.
日本アフェレシス学会の論文
2008-10-31

EBM時代の人工肝補助療法

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