Efficacy of hepatic arterial infusion of prostaglandin E1 in the treatmentof postoperative acute liver failure - Report of a case

Prostaglandin E-1 (PGE(1)) has received attention for its protective effect s against various types of liver damage. However, it is known that approxim ately 70% of PGE(1) is inactivated during a single passage through the lung . Therefore, direct infusion of PGE(1) into the liver bloodstream is prefer able to intravenous infusion. A 66-year-old man with hepatocellular carcino ma with liver cirrhosis developed postoperative acute liver failure followi ng posterior segmentectomy under hepatic total vascular exclusion exceeding 1 hour. Because his liver function did not recover in spite of plasma exch ange starting on postoperative day 8 and intravenous infusion of PGE(1), he patic arterial continuous infusion of PGE(1) at a rate of 0.01 mu g/kg/min was carried out for 7 days from postoperative day 17. Immediately after the start of the arterial infusion, the bile flow significantly increased comp ared to before the arterial infusion, and the serum total bilirubin level d ecreased thereafter and finally recovered from the hepatic failure. In addi tion to its highly Efficient drug delivery, the hepatic arterial infusion o f PGE(1) seems to he more advantageous in oxygen delivery to the liver comp ared with intravenous infusion. In conclusion, the hepatic arterial infusio n of PGE(1) may be useful in the treatment of acute liver failure.