HEMODYNAMIC-CHANGES AFTER HIGH-VOLUME PLASMAPHERESIS IN PATIENTS WITHCHRONIC AND ACUTE LIVER-FAILURE

Objective: To evaluate the haemodynamic changes during treatment with high-volume plasmapheresis in patients with chronic liver failure comp ared to patients with acute liver failure. Methods: Haemodynamic measu rements were performed with a Swan-Ganz catheter and thermodilution te chnique. High-volume plasmapheresis (mean plasma exchange of 8.6 litre s) was performed in 11 patients with chronic and 16 patients with acut e liver failure. Results: In patients with chronic liver failure, syst emic vascular resistance index was unaltered: 1193 +/- 494 dyn s cm(-5 ) m(2) before treatment versus 1180 +/- 399 dyn s cm(-5) m(2) after. M ean arterial pressure increased from 69 +/- 11 mmHg to 78 +/- 13 mmHg (P < 0.05) and cardiac output increased from 8.1 +/- 2.4 l/min to 8.9 +/- 2.4 l/min (P < 0.05) during high-volume plasmapheresis. In patient s with acute liver failure, systemic vascular resistance index increas ed from 1154 +/- 628 dyn s cm(-5) m(2) to 1614 +/- 738 dyn s cm(-5) m( 2) (P < 0.001). In this group mean arterial pressure increased from 78 +/- 6 mmHg to 95 +/- 10 mmHg (P < 0.001) and cardiac output decreased from 9.6 +/- 3.7 l/min to 8.2 +/- 2.9 l/min (P < 0.01). Conclusion: T he hyperkinetic circulation in chronic and acute patients was differen tly affected by high-volume plasmapheresis. We suggest that in chronic liver failure both portosystemic shunting and chronic peripheral vaso dilation may contribute to the hyperkinetic syndrome, whereas in acute liver failure a humoral factor which can be removed by high-volume pl asmapheresis is a main contributor.