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Charcoal-based hemodiabsorption liver support for episodic type C hepatic encephalopathy
Kevin Hill1, Ke-Qin Hu, Alfred Cottrell
1Department of Internal Medicine, Transplantation Institute, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA.
The American Journal of Gastroenterology
|December 23, 2003
Summary
Extracorporeal liver support using charcoal-based hemodiabsorption is a safe and effective treatment for acute hepatic encephalopathy (AHE) unresponsive to medical therapy. This approach significantly improves patient mental status and survival rates.
Area of Science:
- Hepatology
- Gastroenterology
- Critical Care Medicine
Background:
- Episodic (acute) hepatic encephalopathy (AHE) poses a significant treatment challenge, with 10-30% of patients failing to respond to medical therapy and a similar mortality rate.
- Existing medical treatments for AHE are insufficient for a substantial patient subset, necessitating exploration of alternative therapeutic strategies.
Purpose of the Study:
- To prospectively evaluate the safety and efficacy of extracorporeal liver support, specifically charcoal-based hemodiabsorption, for patients with AHE refractory to medical treatment.
- To assess the impact of a standardized anticoagulation protocol on the outcomes and resource utilization during hemodiabsorption therapy.
Main Methods:
- A prospective study involving patients with cirrhosis and AHE unresponsive to at least 24 hours of medical therapy.
- Patients underwent up to three 6-hour sessions of charcoal-based hemodiabsorption (Liver Dialysis Unit).
- A standardized anticoagulation protocol using heparin, guided by activated clotting time (ACT), was implemented and compared to manufacturer's guidelines.
Main Results:
- Out of 18 patients treated, 88.9% showed significant improvement in hepatic encephalopathy (HE) grade or HE index within 2.6 days.
- A significant improvement in median mental status (grade 2 vs. 1) and HE index was observed (p < 0.05 and p < 0.005, respectively).
- The standardized anticoagulation protocol led to reduced consumption of platelets and fibrinogen, and decreased blood product usage compared to manufacturer's guidelines.
Conclusions:
- Charcoal-based hemodiabsorption, when combined with a standardized anticoagulation protocol, represents a safe and effective treatment for AHE unresponsive to conventional medical therapy.
- This extracorporeal approach offers a viable option for improving outcomes in patients with severe AHE.
- The developed anticoagulation strategy optimizes the use of resources and minimizes complications associated with the procedure.