PLASMA SEPARATION AND BILIRUBIN ADSORPTION AFTER COMPLICATED LIVER TRANSPLANTATION: A Therapeutic Approach to Excessive Hyperbilirubinemia

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Abstract

Background.

Severe hyperbilirubinemia is known to exert multiple toxic effects. Thus, a reduction in bilirubin by use of various adsorbent columns has been reported for a variety of hepatic disorders, but no experience with liver transplant patients is available as yet.

Methods.

Plasma separation and bilirubin adsorption by an anion-exchange adsorbent column (BR-350) were performed in two patients with severe jaundice(total serum bilirubin >55 mg/dl) and multiple organ failure that had developed after orthotopic liver transplantation.

Results.

The procedure resulted in an 18% to 35% reduction in total bilirubin after each session, accompanied by a remarkable clinical improvement. Both patients finally recovered and had a favorable outcome. No complications or side effects of bilirubin adsorption were observed during any of the six sessions.

Conclusions.

Bilirubin adsorption is a safe and effective treatment. It should be considered as supportive therapy for excessive hyperbilirubinemia after liver transplantation. In selected cases, retransplantation may thus be avoided.

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