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Case Reports
. 2024 May 12;13(10):2853.
doi: 10.3390/jcm13102853.

Blood Purification in Hepatic Dysfunction after Liver Transplant or Extensive Hepatectomy: Far from the Best-Case Scenarios

Rita Gaspari  1   2 , Paola Aceto  1   2 , Giorgia Spinazzola  2 , Edoardo Piervincenzi  2 , Maurizio Chioffi  2 , Felice Giuliante  3   4 , Massimo Antonelli  1   2 , Alfonso Wolfango Avolio  3   5
Affiliations
Case Reports

Blood Purification in Hepatic Dysfunction after Liver Transplant or Extensive Hepatectomy: Far from the Best-Case Scenarios

Rita Gaspari et al. J Clin Med. .

Abstract

Background: Hepatic dysfunction (HD) after liver transplantation (LT) or extended hepatic resection (EHR) is associated with graft failure and high short-term mortality. We evaluated the safety and depurative efficacy of CytoSorb® in these settings. The primary endpoint was the change in serum total bilirubin at the end of the treatment compared to the baseline value. The secondary endpoint was to evaluate the trend of serum total bilirubin and coagulation parameters up to 72 h after discontinuation of CytoSorb®. The effects of CytoSorb® therapy on the degree of hepatic encephalopathy (HE), Sequential Organ Failure Assessment (SOFA), and Model for End-Stage Liver Disease (MELD) scores as well as the hemodynamic status compared to baseline were also assessed. Methods: Adult patients with a serum total bilirubin level > 10 mg/dL admitted to the Intensive Care Unit were included. Exclusion criteria were hemodynamic instability, postoperative bleeding and platelet count < 20,000/mm3. Results: Seven patients were treated. Serum total bilirubin was significantly reduced at the end of treatment. However, seventy-two hours after the discontinuation of extracorporeal therapy, bilirubin levels returned to baseline levels in four patients. A decrease in platelet count was found during therapy, and platelet transfusion was required in six cases. A significant increase in D-dimer at the end of treatment was detected. HE degree, SOFA and MELD scores remained stable, while a deterioration in hemodynamic status was observed in two cases. Conclusions: Our preliminary findings did not show the possible benefits of CytoSorb® in rebalancing clinical and laboratory parameters in patients with HD after LT or EHR.

Keywords: graft failure; hemoadsorption; liver dysfunction; liver resection; liver transplant.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Management protocol during CytoSorb® therapy. CVVHDF: continuous veno-venous hemodiafiltration; UFH: unfractionated heparin; ACT: activated clotting time.
Figure 2
Figure 2
Flow diagram of the study.
Figure 3
Figure 3
Comparison of biochemical parameters (A: bilirubin; B: Platelets; C: D-dimer) at the beginning, at the end of treatment, 24, 48 and 72 h, after CytoSorb® treatment. re-LT: re-transplant; pt: patient.
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