Coupled Plasma Filtration Adsorption Application for Liver and Thyroid Toxins

Area of Science:

• Nephrology
• Hepatology
• Endocrinology

Background:

• Coupled plasma filtration and adsorption (CPFA) is an extracorporeal detoxification system combining plasma adsorption and continuous renal replacement therapy circuits.
• CPFA is primarily used for sepsis and septic shock, with studies suggesting mortality benefits at specific plasma adsorption volumes (>0.18 L/kg/day).
• Emerging research explores CPFA applications in patients without significant kidney failure.

Observation:

• A successful case of CPFA in acute liver failure following severe cholangitis and hemolytic anemia is presented, resulting in complete liver function recovery.
• CPFA effectively removed bilirubin and protein-bound toxins via the resin, while the hemofilter cleared hydrophilic toxins like ammonia and free bilirubin.
• A second case demonstrated CPFA's efficacy in thyrotoxicosis, adsorbing free triiodothyronine (FT3) and free thyroxine (FT4).

Findings:

• CPFA facilitated the removal of key toxins in acute liver failure and significantly reduced FT3 and FT4 levels in thyrotoxicosis.
• The adsorption efficacy for FT3 and FT4 appeared superior to plasma exchange (PEX).
• The hemofilter component improved hemodynamic tolerance and removed water-soluble toxins, with resin saturation indicating shorter treatment durations in non-renal failure patients.

Implications:

• CPFA demonstrates multipurpose potential, offering a valuable treatment option for conditions resistant to conventional therapies.
• It can serve as a crucial bridge therapy, potentially awaiting liver transplantation or thyroidectomy.
• These findings expand the therapeutic scope of CPFA, highlighting its utility in critical care beyond its traditional applications.