[Artificial liver support system: removal of bilirubin and bile acids by hemoperfusion with ionex-column]

Removal of toxic substances from the circulating blood of patients with severe hepatic failures may be life-saving, however, the substances should be clarified. IONEX is a new resin specially designed to adsorb bilirubin in the blood. The adsorption of bilirubin from the blood to IONEX was 2 to 3 times than that to the activated charcoal beads in vitro. Direct hemoperfusion with IONEX column was performed using 6 jaundiced dogs. Removal rate of bilirubin after 90 minutes direct hemoperfusion ranged from 49% (IONEX 70 gm) maximum to 9% (IONEX 24.1 gm) minimum. It has been found that the removal of bilirubin is disturbed by thrombus formation on the IONEX fibers. To prevent the platelet loss and aggregate formation during hemoperfusion with IOENX, Prostaglandin (PGE1 or PGI2) was administered continuously into the arterial line of the extracorporeal circulation using IONEX column during 90 min. direct hemoperfusion. Thrombus formation in the IONEX column was little observed and the platelet losses were also not observed. The average removal rate of bilirubin from the blood of the jaundiced dogs was as much as 40% (IONEX 70 gm) and that of bile acid was 61% in mean value. Using PGI2, slight hypotension could not be avoided in dog. In 7 patients with severe jaundice, direct hemoperfusion was performed. Mean removal rate of bilirubin and bile acids from the blood of these patients was 21% and 31.2% respectively after 60 to 90 minutes direct hemoperfusion with activated charcoal and IONEX.