J.Jpn. Surg. Soc.. 94(7): 707-713, 1993

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Original article

THERAPEUTIC PLASMAPHERESIS TO TREAT POSTOPERATIVE HEPATIC FAILURE CLINICAL COURSE AND THERAPEUTIC OUTCOME IN JAPAN

The most serious hepatic complication after surgical procedure is postoperative hepatic failure. There is no therapy for this condition except plasma exchange. Precise clinical definition of postoperative hepatic failure was discussed based on a questionnaire distributed by the association in 1989, and in 1991 by the working group.
Giving special consideration to the use of therapeutic plsmapheresis, the clinical definition of postoperative hepatic failure was established as hepatic injury after surgery, without obstructive causative factors, laboratory values for total bilirubin over 5mg/dl with continuous elevation, and hepaplastin activity under 40%. Key factors in determining initiation, efficacy, and cessation of plasmapheresis were coma grade (II-III), total bilirubin levels, and the activities of coagulation tests. The majority of underlying diseases were hepato-biliary in nature. The causative factors of hepatic injuries were massive bleeding and infection. The morbidity was estimated at 600 to 3000 cases/year. The frequency of plasma exchange was one session every/1.4ー1.6 days. The volume of exchanged fresh frozen plasma was about 3292 ml/a session. Nafamostat mesilate was used as an anticoagulant. The survival rate was 14% to 40%. Earlier initiation of plasma exchange is indicated.

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