肝不全におけるPlasma Dia-Filtration (PDF)-Plasma Filtration with Dialysis-療法

概要

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Extracorporeal artificial liver support is needed to allow bridging of liver function until spontaneous recovery occurs or a donor organ has become available for transplantation. Recently, we reported a novel plasmapheresis, Plasma Dia-Filtration (PDF), whose concept is plasma filtration with dialysis. From January 2006 to February 2008, we studied 154 PDF treatments in 22 patients (15men; median age 61; median seven sessions per patient) whose diagnoses were septic liver failure, 32%; postoperative liver failure, 27%; fulminant liver failure, 23%; and sub-acute liver failure, 9%. At the starting point of PDF treatment, the averages (±SD) were 17.7(±7.9) mg/dl for total bilirubin, 2.43(±1.23) for PT (INR), 1.54(±1.05) mg/dl for creatinine (hemodialysis was previously performed in 36% of patients), 32.8(±7.4) for a model for end-stage liver disease (MELD) score. The 3-month survival rate without transplantation was 41% overall, and 57% and 45% in 20-29 and 30-39 of MELD score at the starting point of PDF treatment, respectively. The outcome of PDF treatment was superior to that of albumin dialysis therapy analyzed by previous reports. PDF is a simple modality and may develop to be a useful strategy for treatment of patients with liver failure.
2008-10-31