Albumin dialysis: effective removal of copper in a patient with fulminant Wilson disease and successful bridging to liver transplantation: a new possibility for the elimination of protein-bound toxins

Background: Acute liver failure may be the first manifestation of Wilson di sease. If copper elimination fails, liver transplantation is the only remai ning therapeutic option. Albumin dialysis, a new method for the removal of protein-bound toxins, was performed in a patient with fulminant Wilson dise ase. Methods: An 18-year-old man with Wilson disease presented with hyperacute l iver failure, hepatic encephalopathy III degrees, oligo-anuric renal failur e, haemolytic anaemia, rhabdomyolysis, pancreatitis and thrombocytopenia. H e was treated with albumin dialysis using a 44 gn albumin-containing dialys ate and a slow dialysate flow rate (1-2 I/h), The other details of the tech nique used are similar to routine continuous veno-venous haemodiafiltration . Results: One hundred and five milligrams of copper were removed by albumin dialysis within the first six treatments, resulting in normalisation of blo od-copper levels, Successful treatment of the multiorgan failure was achiev ed. Hepatic encephalopathy improved within 2 days, The patient initially re fused liver transplantation. Therefore 35 additional albumin dialysis treat ments were performed. Forty-three grams of bilirubin (an indicator of detox ified substances in the liver) and 196 mg of copper were removed, Multiorga n failure, in particular hepatic encephalopathy, did not recur during 59 da ys of treatment, Eventually, the patient agreed to liver transplantation an d that was successful. Conclusion: Albumin dialysis is a new method for the effective treatment of fulminant Wilson disease, resulting in the removal of protein-bound toxins copper and bilirubin, It may serve as a new treatment option in hyperacute liver failure of other origin, acting as an extracorporeal detoxifier.