To investigate the role of extracorporeal detoxification in cirrhotic patients with advanced hepatic encephalopathy not responding to medical treatment, 20 patients were randomized to receive six hours of additional sorbent dialysis or ongoing standardized medical treatment. Following treatment, the clinical stage of encephalopathy remained unchanged in both groups. Abnormal sensory evoked potentials improved following sorbent dialysis (N70 latency, 128 ms before versus 110 ms after treatment, P<0,05; cervico-cranial transmission, 7.7 ms versus 6.8 ms, P<0.01) indicating improvement in important aspects of cerebral function. In contrast, brain function remained unchanged following medical treatment (N70 latency, 114 ms versus 113 ms; cervico-cranial transmission, 7.7 ms versus 7.2 ms, P=NS, respectively). Serum benzodiazepine levels decreased significantly after sorbent dialysis but not after medical treatment. Biocompatibility of sorbent dialysis was limited and clinical complications occurred in a proportion of patients. In conclusion, a six-hour treatment with sorbent suspension dialysis did not ameliorate the clinical stage of HE but improved neurophysiologic function in cirrhotic patients who had not responded to conventional medical treatment.
ButterworthR.F., GiuèreJ.F., MichaudJ., LavoieJ., Pomeir-LavarguesG.. Ammonia: A key factor in the pathogenesis of hepatic encephalopathy.Neurochem Pathol1987; 6: 1–12.
HughesR.D., WilliamsR.. Use of bioartificial and artificial liver support devices.Semin Liver Dis1996; 16: 435–44.
6.
O'GradyJ.G., GimsonA.E.S., O'BrienC.J., PucknellA., HughesR.D., WilliamsR.. Controlled trials of charcoal hemoperfusion and prognostic factors in fulminant hepatic failure.Gastroenterology1998; 94: 1186–92.
7.
BleiA.T.. Hepatic encephalopathy in the age of TIPS (Editorial).Hepatology1994; 20: 249–52.
8.
CooperG.S., BellamyP., DawsonN.V.. A prognostic model for patients with end-stage liver disease.Gastroenterology1997; 113: 1278–88.
9.
AshS.R., BlakeD.E., CarrD.J., CarterC., HowardT., MakowkaL.. Clinical effects of a sorbent suspension dialysis system in treatment of hepatic coma (the BioLogic-DT).Int J Artif Organs1992; 15: 151–61.
10.
HughesR.D., PucknellA., RoutleyD., LangleyP.G., WendonJ.A., WilliamsR.. Evaluation of the BioLogic-DT sorbent-suspension dialyzer in patients with fulminant hepatic failure.Int J Artif Organs1994; 17: 657–62.
11.
EllisA.J., HughesR.D., NichollD., LangleyP.G., WendonJ.A., O'GradyJ.G., WilliamsR.. Temporary extracorporeal liver support for severe acute alcoholic hepatitis using the BioLogic-DT.Int J Artif Organs1999; 22: 27–34.
12.
ConnH.O., LieberthalM.M.. The hepatic coma syndromes and lactulose.Baltimore: Williams & Wilkins, 1979.
13.
GrimmG., FerenciP., KatzenschlagerR.. Improvement of hepatic encephalopathy treated with flumazenil.Lancet1988; II: 1392–4.
14.
Van der RijtC.C.D., SchalmS.W., De GrootG.H., De VliegerM.. Objective measurement of hepatic encephalopathy by means of automated EEG analysis.Electroenceph Clin Neurophysiology1984; 57: 423–6.
15.
MullenK.D., SzauterK.M., Kaminsky-RussK.. “Endogenous” benzodiazepine activity in body fluids of patients with hepatic encephalopathy.Lancet1986; 336: 81–3.
16.
RosenH.M., YoshimuraN., HodgmanJ.M., FischerJ.E.. Plasma amino acid patterns in hepatic encephalopathy of different etiology.Gastroenterology1977; 72: 483–7.
17.
KramerL., TriblB., GendoA.. Partial pressure of ammonia versus ammonia in hepatic encephalopathy.Hepatology2000; 31: 30–4.
18.
GrimmG., StockenhuberF., SchneeweissB., MadlC., ZeitlhoferJ., SchneiderB.. Improvement of brain function in hemodialysis patients treated with erythropoietin.Kidney Int1990; 38: 480–6.
19.
ChuN.S., YangS.S.. Portal-systemic encephalopathy: alterations in somatosensory and brainstem evoked potentials.J Neur Sci1988; 84: 41–50.
20.
EpsteinC.M., RietherA.M., HendersonR.M., CotsonisG.A.. EEG in liver transplantation: visual and computerized analysis.Electroenceph Clin Neurophysiology1992; 83: 367–71.
21.
HotzM.A., RitzR., LinderL., Scollo-LavizzariG., HaefeliW.E.. Auditory and electroencephalographic effects of midazolam and alpha-hydroxy-midazolam in healthy subjects.Br J Clin Pharmacol2000; 49: 72–9.
22.
BaktiG., FischH.U., KarlaganisG., MinderC., BircherJ.. Mechanism of the excessive sedative response of cirrhotics to benzodiazepines: model experiments with triazolam.Hepatology1987; 7: 629–38.
23.
Pomier-LayrarguesG., GiguereJ.F., LavoieJ.. Flumazenil in cirrhotic patients in hepatic coma: a randomized double-blind placebo-controlled crossover trial.Hepatology1994; 19: 32–7.
24.
BarbaroG., Di LorenzoG., SoldiniM.. Flumazenil for hepatic encephalopathy grade III and IV in patients with cirrhosis: an Italian multicenter double-blind, placebo-controlled, crossover study.Hepatology1998; 28: 374–8.
25.
NorenbergM.D., BenderA.S.. Astrocyte swelling in liver failure: role of glutamine and benzodiazepines.Acta Neurochir1994; 60(suppl.): S24–7.
26.
CordobaJ., BleiA.T., MujaisS.. Determinants of ammonia clearance by hemodialysis.Int J Artif Organs1996; 20: 800–3.
27.
ClemmesenJ.O., LarsenF.S., KondrupJ., HansenB.A., OttP.. Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentrations.Hepatology1999; 29: 648–53.
28.
RoseC., ButterworthR.F., ZayedJ.. Manganese deposition in basal ganglia structures results from both portal-systemic shunting and liver dysfunction.Gastroenterology1999; 117: 640–4.
29.
KramerL., GendoA., MadlC.. Biocompatibility of a cuprophane-charcoal based detoxification device in cirrhotic patients with hepatic encephalopathy.Am J Kidney Dis2000; 36: 1193–200.
30.
CanivetE., LavaudS., WongT.. Cuprophane but not synthetic membrane induces increases in serum tumor necrosis factor-alpha levels during hemodialysis.Am J Kidney Dis1994; 21: 41–6.
31.
VioliF., FerroD., BasiliS.. Association between low-grade disseminated intravascular coagulation and endotoxemia in patients with liver cirrhosis.Gastroenterology1995; 109: 531–9.
32.
AshS.R.. Hemodiabsorption in treatment of acute hepatic failure and chronic cirrhosis with ascites.Int J Artif Organs1994; 18: 335–62.
33.
StraussE., TramoteR., SilvaE.P.. Double-blind randomized clinical trial comparing neomycin and placebo in the treatment of exogenous hepatic encephalopathy.Hepatogastroenterology1992; 39: 542–5.
