Liver support — regeneration by relief
Bilirubin, bile acids and aromatic amino acids are potentially liver-toxic substances with cell-damaging effects. In acute liver failure, these substances increase continuously. Liver pheresis – originally from Japan and market leader there – removes liver toxins directly from the plasma. Many German clinics offer liver support therapy. It is reimbursed individually for each hospital under the OPS code 8-858 in German DRG-system.
When is the liver support useful?
Even after an extensive partial resection, the liver is capable of almost complete regeneration. In order to support this special ability to regenerate and gain time, it makes sense to remove potentially liver-toxic substances such as bilirubin, bile acids and aromatic amino acids. With liver pheresis, severe complications of acute liver failure should be minimised as much as possible. Due to its high biocompatibility, the Plasorba BR-350 can adsorb liver toxins directly from the plasma.
How does the liver support work?
The blood is fed into the first filter, the Plasmaflo OP plasma separator, via a central access point (red). There the plasma (yellow) is separated from the cell-rich fraction of the blood. This plasma contains the free and albumin-bound liver toxins, including bilirubin, bile acids and aromatic amino acids. These substances are bound in the Plasorba BR-350 liver adsorber. The “cleaned” plasma is then combined with the cell-rich fraction of the blood. The patient then receives his or her own “purified” blood back (blue).
During a typical liver pheresis, up to 8 litres of plasma (2–3 plasma volumes) are treated in 3–4 hours and bilirubin, bile acids, and aromatic amino acids are selectively removed. An additional albumin circuit or albumin substitution is not necessary. It is recommended to start treatment as early as possible if the bilirubin level is 20 mg/dl (340 µmol/l) or higher (Senf et al., 2004).
Essential plasma proteins remain in the blood
Rapid detoxification can be achieved with daily liver pheresis and a start as early as possible. The aim is to regenerate the liver as quickly as possible by relieving it of toxic substances. Important plasma components such as coagulation factors and immunoglobulins remain almost unaffected.
Liver support and dialysis – the sequential combination therapy
Following daily liver pheresis, additional soluble potential toxins can be removed over 15-20 hours of dialysis. This sequential combination therapy achieves optimised detoxification by effectively removing both protein-bound and soluble toxins.
The adsorption profile of the BR-350 adsorber
Liver toxins are efficiently and specifically removed. Albumin, immunoglobulins and coagulation factors are hardly reduced. In addition, endotoxins, lipopolysaccharides and HMGB1 can be removed. The BR-350 is therefore ideally suited for liver support therapy (Morimoto et al., 1989).
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The following information is intended for healthcare professionals only.
The information in the section ‚products & therapies‘ is intended to provide explanatory, scientific, and evidence-based answers to medical questions about therapeutic apheresis.
This information does not constitute medical advice. The responsibility for patient care rests with the healthcare professional based on their professional licensure, experience, and knowledge of the patient.