Double Plasma Molecular Adsorption Systemas Treatment of Liver Failure: A Case Series

Introduction: The use of extracorporeal liver support systems (ECLS) as a bridge to liver transplantation or recovery has improved in recent years. We present two cases in which double plasma molecular adsorption system (DPMAS) was applied, resulting in progressive improvements in clinical condition and laboratory values of bilirubin and inflammatory markers. Case Description: Case 1 - A 55-year-old female with AIH for 4 years, in treatment with immunosuppressants. She began one week before with jaundice, Grade I hepatic encephalopathy, and ascites. Laboratory test: Hb 8.9 g/dL, platelets 54,000, INR 2.84, aPTT 55.9 s; Cr 0.73 mg/dL; urea 72.8 mg/dL; BT 14.5 mg/dL, BD 10.2 mg/dL, BI.3 mg/dL; AST 97 U/L; ALT 60 U/L; GGT 43 UI/dL. MELD score of 28 points and Child-Pugh C. On the fifth day laboratory values: Cr 1.71 mg/dL, BUN 61.7 mg/dL, BT 21.9 mg/dL, BD 15.7 mg/dL; we performed 3 sessions of DPMAS, on alternate days, with TPE2000 filter cartridge HA330 II and BS 330. Each session lasted 6 hrs with a plasma volume of 1.5 for DPMAS and 1 time for TPE. The Qb was 130-150 ml/min and Qr post 1300 -1400 ml. RRT technique was CVVHDF. IL-6 decreased from 2707 pg/mL to 993 pg/mL. Case 2 - A 51-year-old male with Chronic Hepatitis C, who began 12 hours before admission with Grade II hepatic encephalopathy and mucocutaneous jaundice. On admission, the laboratory tests were: Hb 12.4 g/dL, platelets 219,000, INR 1.94, aPTT 46.9 s; Cr 2.38 mg/dL; urea 38 mg/dL; BT 22.14 mg/dL, BD 0.74 mg/dL, BI 21.4 mg/dL; AST 297 U/L; ALT 402 U/L; GGT 169 UI/dL, ALP 135 U/L. On the third day with worsening of his clinical condition, it was decided to start MARS for two sessions and later two DPMAS sessions. Discussion: The DPMAS is a blood purification method that is safe and effective for reducing bilirubin levels and inflammatory markers, making it an important option for bridging to transplant or recovery. This could be observed in our patients, in whom the bilirubin and IL-6 levels decreased significantly after treatment with DPMAS.