Blood Purification

Research Article

Single-Pass Albumin Dialysis in the Treatment of Children with Liver Failure

Holle J.a,b · Gratopp A.a · Balmer S.a · Varnholt V.a · Henning S.b · Bufler P.b · Müller D.b · Rosenfeld L.a

Author affiliations

aDepartment of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
bDepartment of Pediatric Gastroenterology, Nephrology and Metabolic Diseases,Charité-Universitätsmedizin Berlin, Berlin, Germany

Keywords: Liver failureLiver transplantationLiver support therapy  Chronic liver failureHepatic encephalopathyAlbumin dialysis

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Blood Purif 2020;49:55–62
https://doi.org/10.1159/000502938

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Article / Publication Details

First-Page Preview
Abstract of Research Article

Received: June 13, 2019
Accepted: August 25, 2019
Published online: September 17, 2019
Issue release date: March 2020

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 2

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Background and Aims: Acute and acute on chronic liver failure are life-threatening conditions, and bridging to transplantation is complicated by a paucity of suitable organs for children. While different modalities of extracorporeal liver support exist, their use in children is complicated by a large extracorporeal volume, and data on their use in children is limited. The aim of this analysis was to investigate the efficacy and safety of single-pass albumin dialysis (SPAD) in children with liver failure. Methods: Retrospective medical chart review of pediatric patients with liver failure treated with SPAD. The decrease in hepatic encephalopathy (HE) and the serum levels of bilirubin and ammonia were measured to determine efficacy. Adverse events were documented to assess safety. Results: Nineteen pediatric patients with a median age of 25.5 months and a median body weight of 11.9 kg were treated with SPAD between January 2011 and March 2018. Total bilirubin (p < 0.001) and ammonia (p = 0.02) significantly decreased after treatment with SPAD. As clinical outcome parameter, HE significantly improved (p = 0.001). Twelve patients were bridged successfully to liver transplantation. In all patients, 71 SPAD sessions were run. Clotting in the dialysis circuit was observed in 49% of all sessions. Heparin and citrate were used for anticoagulation and were significantly superior to dialysis without any anticoagulation (p= 0.03). Transfusion of packed blood cells (57%) and catecholamine therapy (49%) were frequently necessary. Conclusions: Treatment with SPAD was effective in detoxification, as measured by significant improvement of HE and clearance from surrogate laboratory parameters.

© 2019 S. Karger AG, Basel



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Article / Publication Details

First-Page Preview
Abstract of Research Article

Received: June 13, 2019
Accepted: August 25, 2019
Published online: September 17, 2019
Issue release date: March 2020

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 2

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

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