Impact of plasma adsorption volumes (5 L vs. 6 L) on the prognosis of patients with liver failure.
Impacto de los volúmenes de adsorción plasmática (5 L vs. 6 L) en el pronóstico de pacientes con insuficiencia hepática.
Palabras clave:
Adsorción Plasmática, Insuficiencia Hepática, Complicaciones, Duración de la Terapia, Plaquetas
Resumen
La adsorción plasmática (AP) se utiliza para mejorar los resultados en la insuficiencia hepática (IH). Faltan datos relevantes sobre las diferentes capacidades de adsorción y su efecto en la recuperación de los pacientes. Este estudio retrospectivo unicéntrico incluyó a pacientes con IH que recibieron AP en el First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, China, entre octubre de 2020 y octubre de 2022, y examinó el impacto del volumen de adsorción (5 L frente a 6 L) en el pronóstico. El estudio incluyó 230 tratamientos de AP, de los cuales nueve fueron excluidos por falta de datos. Se utilizó la columna de 5 L en 60 pacientes (118 tratamientos) y la de 6 L en 50 pacientes (103 tratamientos). La efectividad se evaluó mediante la duración de la estancia hospitalaria, el trasplante hepático, la muerte y la mejoría de los síntomas relacionados con la enfermedad. En ambos grupos, la AP aumentó los leucocitos, el INR, la APTT y el PT, y disminuyó la hemoglobina, los ácidos biliares totales, la bilirrubina total y el fibrinógeno (todos p<0,05). Los niveles de plaquetas disminuyeron después de la AP de 6 L (p=0,033), pero no con la de 5 L (p=0,116). Tras la AP, el grupo de 6 L mostró leucocitos más bajos (p=0,003). Las columnas de 5 L y 6 L no mostraron diferencias significativas en los resultados clínicos principales. Sin embargo, la columna de 5 L redujo significativamente la destrucción plaquetaria y acortó el tiempo de tratamiento, lo que sugiere que el volumen de 5 L podría ser clínicamente preferible.
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Lee JY, Kim SB, Chang JW, Park SK, Kwon SW, Song KW, et al. Comparison of the molecular adsorbent recirculating system and plasmapheresis for patients with graft dysfunction after liver transplantation. Transplant Proc. 2010;42(7):2625-2630. https://doi.org/10.1016/j.transproceed.2010.04.070.
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Alarabi AA, Wikstrom B, Loof L, Danielson BG. Treatment of pruritus in cholestatic jaundice by bilirubin- and bile acid-adsorbing resin column plasma perfusion. Scand J Gastroenterol. 1992;27(3):223-226. https://doi.org/10.3109/00365529208999953.
Mandiga P, Kommu S, Foris LA, Bollu PC. Hepatic Encephalopathy. In: StatPearls. Treasure Island (FL); StatPearls Publishing; 2026. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430869/
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Viggiano D, de Pascale E, Marinelli G, Pluvio C. A comparison among three different apheretic techniques for treatment of hyperbilirubinemia. J Artif Organs. 2018;21(1):110-116. https://doi.org/10.1007/s10047-017-0986-1.
Fuhrmann V, Horvatits T, Drolz A, Rutter K. [Extracorporeal therapy of patients with liver disease in the intensive care unit]. Med Klin Intensivmed Notfmed. 2014;109(4):246-251. https://doi.org/10.1007/s00063-013-0321-4.
Saliba F, Bañares R, Larsen FS, Wilmer A, Parés A, Mitzner S, et al. Artificial liver support in patients with liver failure: a modified DELPHI consensus of international experts. Intensive Care Med. 2022;48(10):1352-1367, https://doi.org/10.1007/s00134-022-06802-1.
Sun Y, Yu LX, Liu YH, Wang B, Lu W. [Bilirubin adsorption therapy for two infants with liver failure]. Zhonghua Er Ke Za Zhi. 2020;58(11):933-934. https://doi.org/10.3760/cma.j.cn112140-20200411-00376.
Tsipotis E, Shuja A, Jaber BL. Albumin Dialysis for Liver Failure: A Systematic Review. Adv Chronic Kidney Dis. 2015;22(5):382-390. https://doi.org/10.1053/j.ackd.2015.05.004.
Adani GL, Lorenzin D, Currò G, Sainz-Barriga M, Comuzzi C, Bresadola V, et al. Selective bilirubin removal by plasma treatment with Plasorba BR-350 for early cholestatic graft dysfunction. Transplant Proc. 2007;39(6):1904-1906. https://doi.org/10.1016/j.transproceed.2007.05.010.
Geiger H, Klepper J, Lux P, Heidland A. Biochemical assessment and clinical evaluation of a bilirubin adsorbent column (BR-350) in critically ill patients with intractable jaundice. Int J Artif Organs. 1992;15(1):35-39. PMID: 1551726.
Borberg H. Comparison of different Lp (a) elimination techniques: a retrospective evaluation. Transfus Apher Sci. 2009;41(1):61-65. https://doi.org/10.1016/j.transci.2009.05.014.
Ihara H, Shino Y, Hashizume N, Aoki T, Suzuki Y, Igarasi Y, et al. Decline in plasma retinol in unconjugated hyperbilirubinemia treated with bilirubin adsorption using an anion-exchange resin. J Nutr Sci Vitaminol (Tokyo). 1998;44(2):329-336. https://doi.org/10.3177/jnso.44.329.
Ryan CJ, Anilkumar T, Ben-Hamida AJ, Khorsandi SE, Aslam M, Pusey CD, et al. Multisorbent plasma perfusion in fulminant hepatic failure: effects of duration and frequency of treatment in rats with grade III hepatic coma. Artif Organs. 2001;25(2):109-118. https://doi.org/10.1046/j.1525-1594.2001.025002109.x.
Mertens PR, Schönfelder T, Handt S, Kierdorf H, Marschall H, Busch N, et al. Long-term extracorporeal bilirubin elimination: A case report on cascade resin plasmaperfusion. Blood Purif. 1998;16(6):341-348. https://doi.org/10.1159/000014354.
Thijssen S, Kappel F, Kotanko P. Absolute blood volume in hemodialysis patients: why is it relevant, and how to measure it? Blood Purif. 2013;35(1-3):63-71. https://doi.org/10.1159/000345484.
Nafisi VR, Eghbal M. Optimized Blood Volume Monitoring during Hemodialysis Procedure based on Ultrasonic Speed Measurement. J Biomed Phys Eng. 2019;9(3):373-380. https://doi.org/10.31661/jbpe.v9i3.Jun.675.
Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association, Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. [Guideline for diagnosis and treatment of liver failure (2018)]. Zhonghua Gan Zang Bing Za Zhi. 2019;27(1):18-26. https://doi.org/10.3760/cma.j.issn.1007-3418.2019.01.006.
Kaplan AA. A simple and accurate method for prescribing plasma exchange. ASAIO Trans. 1990;36(3):M597-599. PMID: 2252761.
Liang C, Takahashi K, Furuya K, Oda T, Ohkohchi N. Platelets Stimulate Liver Regeneration in a Rat Model of Partial Liver Transplantation. Liver Transpl. 2021;27(5):719-734. https://doi.org/10.1002/lt.25962.
Chamuleau RA, Aronson DC, Frederiks WM, Bosman DK, Smit JJ, Maas MA, et al. Liver regeneration after partial hepatectomy in rats with defective bilirubin conjugation or biliary excretion. Dig Dis Sci. 1991;36(4):510-512. https://doi.org/10.1007/BF01298884.
Larsen FS. Artificial liver support in acute and acute-on-chronic liver failure. Curr Opin Crit Care. 2019;25(2):187-191. https://doi.org/10.1097/MCC.0000000000000584.
Che XQ, Li ZQ, Chen Z, Guo D, Jia QY, Jiang SC, et al. Plasma exchange combining with plasma bilirubin adsorption effectively removes toxic substances and improves liver functions of hepatic failure patients. Eur Rev Med Pharmacol Sci. 2018;22(4):1118-1125. https://doi.org/10.26355/eurrev_201802_14400.
Senf R, Klingel R, Kurz S, Tullius S, Sauer I, Frei U, et al. Bilirubin-adsorption in 23 critically ill patients with liver failure. Int J Artif Organs. 2004;27(8):717-722. https://doi.org/10.1177/039139880402700810.
Schwanke AA, Danski MTR, Pontes L, Kusma SZ, Lind J. Central venous catheter for hemodialysis: incidence of infection and risk factors. Rev Bras Enferm. 2018;71(3):1115-1121. https://doi.org/10.1590/0034-7167-2017-0047.
Daugirdas JT, Bernardo AA. Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia. Kidney Int. 2012;82(2):147-157. https://doi.org/10.1038/ki.2012.130.
Doi Y, Koga K, Sugioka S, Inoue Y, Arisato T, Nishioka K, et al. Heparin-induced thrombocytopenia among incident hemodialysis patients anticoagulated with low molecular weight heparin: A single-center retrospective study. Nefrologia (Engl Ed). 2021;41(3):356-358. https://doi.org/10.1016/j.nefroe.2020.05.007.
Hakim RM, Schafer AI. Hemodialysis-associated platelet activation and thrombocytopenia. Am J Med. 1985;78(4):575-580. https://doi.org/10.1016/0002-9343(85)90398-5.
Giannini EG, Peck-Radosavljevic M. Platelet Dysfunction: Status of Thrombopoietin in Thrombocytopenia Associated with Chronic Liver Failure. Semin Thromb Hemost. 2015;41(5):455-461. https://doi.org/10.1055/s-0035-1550432.
Fathi M. Heparin-induced thrombocytopenia (HIT): Identification and treatment pathways. Glob Cardiol Sci Pract. 2018;2018(2):15. https://doi.org/10.21542/gcsp.2018.15.
Khan MTA, Patnaik R, Huang JY, Campi HD, Montorfano L, De Stefano F, et al. Leukopenia is an independent risk factor for early postoperative complications following incision and drainage of anorectal abscess. Colorectal Dis. 2023;25(4):717-727. https://doi.org/10.1111/codi.16447.
Angeli P, Rodríguez E, Piano S, Ariza X, Morando F, Solà E, et al. Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis. Gut. 2015;64(10):1616-1622. https://doi.org/10.1136/gutjnl-2014-307526.
Lee JY, Kim SB, Chang JW, Park SK, Kwon SW, Song KW, et al. Comparison of the molecular adsorbent recirculating system and plasmapheresis for patients with graft dysfunction after liver transplantation. Transplant Proc. 2010;42(7):2625-2630. https://doi.org/10.1016/j.transproceed.2010.04.070.
European Association for the Study of the Liver, Electronic address eee, Clinical practice guidelines panel, Wendon J, Panel members, Cordoba J, et al. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017;66(5):1047-1081. https://doi.org/10.1016/j.jhep.2016.12.003.
Alarabi AA, Wikstrom B, Loof L, Danielson BG. Treatment of pruritus in cholestatic jaundice by bilirubin- and bile acid-adsorbing resin column plasma perfusion. Scand J Gastroenterol. 1992;27(3):223-226. https://doi.org/10.3109/00365529208999953.
Mandiga P, Kommu S, Foris LA, Bollu PC. Hepatic Encephalopathy. In: StatPearls. Treasure Island (FL); StatPearls Publishing; 2026. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430869/
Francoz C, Durand F, Kahn JA, Genyk YS, Nadim MK. Hepatorenal Syndrome. Clin J Am Soc Nephrol. 2019;14(5):774-781. https://doi.org/10.2215/CJN.12451018.
Viggiano D, de Pascale E, Marinelli G, Pluvio C. A comparison among three different apheretic techniques for treatment of hyperbilirubinemia. J Artif Organs. 2018;21(1):110-116. https://doi.org/10.1007/s10047-017-0986-1.
Fuhrmann V, Horvatits T, Drolz A, Rutter K. [Extracorporeal therapy of patients with liver disease in the intensive care unit]. Med Klin Intensivmed Notfmed. 2014;109(4):246-251. https://doi.org/10.1007/s00063-013-0321-4.
Saliba F, Bañares R, Larsen FS, Wilmer A, Parés A, Mitzner S, et al. Artificial liver support in patients with liver failure: a modified DELPHI consensus of international experts. Intensive Care Med. 2022;48(10):1352-1367, https://doi.org/10.1007/s00134-022-06802-1.
Sun Y, Yu LX, Liu YH, Wang B, Lu W. [Bilirubin adsorption therapy for two infants with liver failure]. Zhonghua Er Ke Za Zhi. 2020;58(11):933-934. https://doi.org/10.3760/cma.j.cn112140-20200411-00376.
Tsipotis E, Shuja A, Jaber BL. Albumin Dialysis for Liver Failure: A Systematic Review. Adv Chronic Kidney Dis. 2015;22(5):382-390. https://doi.org/10.1053/j.ackd.2015.05.004.
Adani GL, Lorenzin D, Currò G, Sainz-Barriga M, Comuzzi C, Bresadola V, et al. Selective bilirubin removal by plasma treatment with Plasorba BR-350 for early cholestatic graft dysfunction. Transplant Proc. 2007;39(6):1904-1906. https://doi.org/10.1016/j.transproceed.2007.05.010.
Geiger H, Klepper J, Lux P, Heidland A. Biochemical assessment and clinical evaluation of a bilirubin adsorbent column (BR-350) in critically ill patients with intractable jaundice. Int J Artif Organs. 1992;15(1):35-39. PMID: 1551726.
Borberg H. Comparison of different Lp (a) elimination techniques: a retrospective evaluation. Transfus Apher Sci. 2009;41(1):61-65. https://doi.org/10.1016/j.transci.2009.05.014.
Ihara H, Shino Y, Hashizume N, Aoki T, Suzuki Y, Igarasi Y, et al. Decline in plasma retinol in unconjugated hyperbilirubinemia treated with bilirubin adsorption using an anion-exchange resin. J Nutr Sci Vitaminol (Tokyo). 1998;44(2):329-336. https://doi.org/10.3177/jnso.44.329.
Ryan CJ, Anilkumar T, Ben-Hamida AJ, Khorsandi SE, Aslam M, Pusey CD, et al. Multisorbent plasma perfusion in fulminant hepatic failure: effects of duration and frequency of treatment in rats with grade III hepatic coma. Artif Organs. 2001;25(2):109-118. https://doi.org/10.1046/j.1525-1594.2001.025002109.x.
Mertens PR, Schönfelder T, Handt S, Kierdorf H, Marschall H, Busch N, et al. Long-term extracorporeal bilirubin elimination: A case report on cascade resin plasmaperfusion. Blood Purif. 1998;16(6):341-348. https://doi.org/10.1159/000014354.
Thijssen S, Kappel F, Kotanko P. Absolute blood volume in hemodialysis patients: why is it relevant, and how to measure it? Blood Purif. 2013;35(1-3):63-71. https://doi.org/10.1159/000345484.
Nafisi VR, Eghbal M. Optimized Blood Volume Monitoring during Hemodialysis Procedure based on Ultrasonic Speed Measurement. J Biomed Phys Eng. 2019;9(3):373-380. https://doi.org/10.31661/jbpe.v9i3.Jun.675.
Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association, Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. [Guideline for diagnosis and treatment of liver failure (2018)]. Zhonghua Gan Zang Bing Za Zhi. 2019;27(1):18-26. https://doi.org/10.3760/cma.j.issn.1007-3418.2019.01.006.
Kaplan AA. A simple and accurate method for prescribing plasma exchange. ASAIO Trans. 1990;36(3):M597-599. PMID: 2252761.
Liang C, Takahashi K, Furuya K, Oda T, Ohkohchi N. Platelets Stimulate Liver Regeneration in a Rat Model of Partial Liver Transplantation. Liver Transpl. 2021;27(5):719-734. https://doi.org/10.1002/lt.25962.
Chamuleau RA, Aronson DC, Frederiks WM, Bosman DK, Smit JJ, Maas MA, et al. Liver regeneration after partial hepatectomy in rats with defective bilirubin conjugation or biliary excretion. Dig Dis Sci. 1991;36(4):510-512. https://doi.org/10.1007/BF01298884.
Larsen FS. Artificial liver support in acute and acute-on-chronic liver failure. Curr Opin Crit Care. 2019;25(2):187-191. https://doi.org/10.1097/MCC.0000000000000584.
Che XQ, Li ZQ, Chen Z, Guo D, Jia QY, Jiang SC, et al. Plasma exchange combining with plasma bilirubin adsorption effectively removes toxic substances and improves liver functions of hepatic failure patients. Eur Rev Med Pharmacol Sci. 2018;22(4):1118-1125. https://doi.org/10.26355/eurrev_201802_14400.
Senf R, Klingel R, Kurz S, Tullius S, Sauer I, Frei U, et al. Bilirubin-adsorption in 23 critically ill patients with liver failure. Int J Artif Organs. 2004;27(8):717-722. https://doi.org/10.1177/039139880402700810.
Schwanke AA, Danski MTR, Pontes L, Kusma SZ, Lind J. Central venous catheter for hemodialysis: incidence of infection and risk factors. Rev Bras Enferm. 2018;71(3):1115-1121. https://doi.org/10.1590/0034-7167-2017-0047.
Daugirdas JT, Bernardo AA. Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia. Kidney Int. 2012;82(2):147-157. https://doi.org/10.1038/ki.2012.130.
Doi Y, Koga K, Sugioka S, Inoue Y, Arisato T, Nishioka K, et al. Heparin-induced thrombocytopenia among incident hemodialysis patients anticoagulated with low molecular weight heparin: A single-center retrospective study. Nefrologia (Engl Ed). 2021;41(3):356-358. https://doi.org/10.1016/j.nefroe.2020.05.007.
Hakim RM, Schafer AI. Hemodialysis-associated platelet activation and thrombocytopenia. Am J Med. 1985;78(4):575-580. https://doi.org/10.1016/0002-9343(85)90398-5.
Giannini EG, Peck-Radosavljevic M. Platelet Dysfunction: Status of Thrombopoietin in Thrombocytopenia Associated with Chronic Liver Failure. Semin Thromb Hemost. 2015;41(5):455-461. https://doi.org/10.1055/s-0035-1550432.
Fathi M. Heparin-induced thrombocytopenia (HIT): Identification and treatment pathways. Glob Cardiol Sci Pract. 2018;2018(2):15. https://doi.org/10.21542/gcsp.2018.15.
Khan MTA, Patnaik R, Huang JY, Campi HD, Montorfano L, De Stefano F, et al. Leukopenia is an independent risk factor for early postoperative complications following incision and drainage of anorectal abscess. Colorectal Dis. 2023;25(4):717-727. https://doi.org/10.1111/codi.16447.
Publicado
2026-05-31
Cómo citar
Zhang, X., Zhang, Z., Chen , H., & Zhang, H. (2026). Impact of plasma adsorption volumes (5 L vs. 6 L) on the prognosis of patients with liver failure.: Impacto de los volúmenes de adsorción plasmática (5 L vs. 6 L) en el pronóstico de pacientes con insuficiencia hepática. Investigación Clínica, 67(2), 230-240. https://doi.org/10.54817/IC.v67n2a06
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