EXCHANGE-TRANSFUSION AND MAJOR SURGERY IN ACUTE HEPATIC-FAILURE

Of the many techniques available for short-term support of the failing liver, a closed isovolemic method of exchange transfusions remains simple and safe. This method was used to exchange 143 U [units] of blood in 8 patients in Stage III/IV hepatic failure; 4 patients had no previous underlying liver disease. Significant improvements of biochemical and coagulation parameters resulted. Serum bilirubin, glutamic oxaloacetic transaminase and lactic dehydrogenase levels fell from a mean, 24.7 mg/100 ml, 3100 mU/ml, 2796 mU/ml, respectively, to 10.9 mg/100 ml, 122.9 mU/ml, and 558.5 mU/ml, respectively, 6-12 h following transfusion. Prolongation of serum prothrombin and thrombin times (over controls) of 31.1 and 30.1 s (mean) were markedly decreased to 3.2 and 6.1 s 6 to 12 h following transfusion; partial thromboplastin times were decreased from a mean 196.4 s to 87.8 s after the same period. Levels of Factors VII, IX and X were increased transiently. Correlations of exchange transfusion to reversal of coma and improvements in EEG were poor. Two patients in coma were subjected to major surgery following exchange transfusion; 1 patient survived vagotomy and hemigastrectomy for stress bleeding, and 1 withstood a temporary baboon liver heterotopic transplant which aided in recovery from coma. Isovolemic exchange transfusion is recommended as specific treatment for coagulation abnormalities and as an over-all aid in lowering the mortality rate of patients in hepatic coma. Marked improvements in homeostasis make major surgery feasible.