Search

Currently there is no direct therapy for liver failure. We have previously described selective plasma exchange therapy using a hemofilter permeable to substances that have a molecular mass of up to 100 kDa. The proof-of-concept studies and a Phase I study in patients with decompensated cirrhosis demonstrated that hemofiltration using an albumin-leaking membrane is safe and effective in removing target molecules, alleviating severe encephalopathy and improving blood chemistry. In this study a novel large-pore filter for similar clinical application is described. The performance of the filter was studied in vitro; it was found to effectively remove a wide spectrum of pathogenic factors implicated in the pathophysiology of hepatic failure, including protein bound toxins and defective forms of circulating albumin. Data on mass transport characteristics and functionality using various modes of filtration and dialysis provide rationale for clinical evaluation of the filter for artificial liver support using albumin apheresis., (© 2018 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.)

Technical problems during clinical lipid apheresis interfere with fractionator performance. Therefore, a large animal model was established to characterize a new plasma fractionation membrane. Four sheep were randomized, controlled, and crossover subjected to double ofiltration lipoprotein apheresis with three specimens of FractioPES R having slightly different HDL sieving coefficients (S K ) (FPESa, 0.30, FPESb, 0.26, and FPESc, 0.22) versus a control fractionator (EVAL). S K and reduction ratios were determined for LDL, HDL, fibrinogen, IgG, and albumin. Compared to EVAL (0.42 ± 0.04 to 0.74 ± 0.08) and FPESa (0.36 ± 0.06 to 0.64 ± 0.04), S K for HDL were lower (P < 0.05) with FPESc (0.30 ± 0.04 to 0.49 ± 0.10). Fibrinogen S K were higher (P < 0.05) with EVAL (0.02 ± 0.01 to 0.40 ± 0.08) compared to FPESb (0.05 ± 0.02 to 0.26 ± 0.34) and FPESc (0.01 ± 0.01 to 0.21 ± 0.16). No further differences were determined. The animal model distinguished between minor differences in fractionation membrane permeability, demonstrating equivalent sieving of FPESa and EVAL and slightly inferior permeability of FPESb and FPESc., (© 2018 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.)