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Published on: September 13, 2014
Continuous veno-venous single-pass albumin hemodiafiltration in children with acute liver failure
Hannelore Ringe1, Verena Varnholt, Miriam Zimmering
1Pediatric Interdisciplinary Intensive Care Unit, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany. hannelore.ringe@charite.de
Insights
Single-pass albumin dialysis effectively detoxified children with acute liver failure, improving their condition and bridging them to liver transplantation. This albumin-based treatment showed promise in enhancing survival rates and preventing neurological complications.
Area of Science:
- Pediatric Critical Care Medicine
- Hepatology
- Renal Replacement Therapy
Background:
- Acute liver failure (ALF) in children presents a critical medical challenge, often necessitating intensive support and liver transplantation.
- Detoxification therapies are crucial for stabilizing patients with ALF, aiming to improve outcomes while awaiting definitive treatment or native liver recovery.
Purpose of the Study:
- To evaluate the applicability, efficacy, and safety of single-pass albumin dialysis (SPAD) as a rescue therapy for pediatric patients with acute liver failure.
- To assess SPAD's potential in bridging children with ALF to liver transplantation or native liver recovery.
Main Methods:
- A retrospective analysis of uncontrolled clinical data from nine pediatric patients (aged 2-15 years) with ALF treated under a compassionate-use protocol.
- SPAD was administered as a rescue intervention for patients meeting high-urgency liver transplantation criteria.
- Efficacy was assessed by measuring reductions in hepatic encephalopathy, serum bilirubin, bile acids, and ammonium levels, alongside liver synthesis function markers (thromboplastin time, fibrinogen). Safety was evaluated by monitoring adverse events, including blood pressure and platelet count changes.
Main Results:
- Seven of nine patients were successfully bridged to either native organ recovery (n=1) or liver transplantation (n=6).
- Six patients survived, with SPAD treatments (n=10) leading to at least a one-degree reduction in hepatic encephalopathy in six individuals.
- All patients demonstrated decreased levels of ammonium, bilirubin, and bile acids; one patient experienced an allergic reaction to albumin.
Conclusions:
- Single-pass albumin dialysis is generally well-tolerated in children with ALF, demonstrating effectiveness in detoxification and improving hemodynamic stability.
- SPAD shows potential in stabilizing critically ill children, facilitating bridging to liver transplantation, and possibly preventing severe neurologic sequelae, thereby improving survival.
- This albumin-based detoxification system is cost-effective, easy to implement, and requires minimal training, though its role in supporting native liver recovery requires further investigation.
Objective:
To investigate the applicability, efficacy, and safety of single-pass albumin dialysis in children.
Design:
Retrospective data review of uncontrolled clinical data.
Setting:
University-based pediatric intensive care unit collaborating with a local center for liver transplantation.
Patients:
Nine children, aged 2 to 15 yrs, who were treated with single-pass albumin dialysis for acute liver failure of various origins under a compassionate-use protocol between 2000 and 2006. All patients met high-urgency liver transplantation criteria.
Interventions:
Single-pass albumin dialysis was performed as rescue therapy for children with acute liver failure.
Measurements And Main Results:
The decrease in hepatic encephalopathy (grades 1-4) and the serum levels of bilirubin, bile acids, and ammonium were measured to assess the efficacy of detoxification. As a measure of liver synthesis function, thromboplastin time and fibrinogen were analyzed. The safety of the procedure was assessed by documenting adverse effects on mean arterial blood pressure, platelet count, and clinical course. Seven out of nine patients were bridged successfully to either native organ recovery (n = 1) or liver transplantation (n = 6), one of them twice. Six out of nine patients undergoing single-pass albumin dialysis (ten treatments) survived. In six patients, hepatic encephalopathy could be reduced at least by one degree. Ammonium, bilirubin, and bile acid levels decreased in all patients. One patient had an allergic reaction to albumin.
Conclusions:
In childhood acute liver failure, treatment with single-pass albumin dialysis was generally well tolerated and seems to be effective in detoxification and in improving blood pressure, thus stabilizing the critical condition of children before liver transplantation and facilitating bridging to liver transplantation. It may be beneficial in avoiding severe neurologic sequelae after acute liver failure and thereby improve survival. Single-pass albumin dialysis is an inexpensive albumin-based detoxification system that is easy to set up and requires little training. Whether and to what extent single-pass albumin dialysis can support children with acute liver failure until native liver recovery remains unclear.
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