Exchange transfusion in hepatorenal syndrome with liver disease

Ten patients with severe liver disease and the hepatorenal syndrome underwent exchange transfusions with 9 to 16 units of fresh heparinized blood to improve renal function by either removing a vasoconstrictive substance or adding a vasodilatory substance. One patient recovered from renal failure within ten days without showing natriuresis. The renal function of one patient improved somewhat, but he died 35 days after the transfusion. The other eight aptients died from 1 to 35 days after exchange transfusion, without any appreciable improvement in renal function. In six patients, renin substrate levels increased after the transfusion, but renal function remained unchanged. The results of this study failed to support a humoral concept of pathogenesis of the hepatorenal syndrome.