Peritoneal Dialysis in Fulminant Hepatic Failure

Abstract

None of the modes of temporary liver support seems to improve survival in fulminant hepatic failure complicated by “grade four” coma. The authors assessed the efficacy of rapid exchange peritoneal dialysis in five consecutive patients with fulminant hepatic failure and grade four coma. Four had concurrent acute renal failure and the prognosis for combined hepatic and renal failure is extremely poor irrespective of mode of therapy. Despite this poor prognosis, three of the five recovered completely, four regained consciousness during the initial peritoneal dialysis and the level of consciousness improved during six of 10 periods of peritoneal dialysis. Two of these patients died two weeks after beginning peritoneal dialysis; and in both autopsy showed massive hepatic necrosis and no evidence of hepatic regeneration. These preliminary results compare favorably with those of hemoperfusion in grade four coma. We conclude that rapid exchange peritoneal dialysis offers a number of theoretical advantages over hemo perfusion and merits further evaluation in the management of fulminant hepatic failure.