Prostaglandin E-1 continuous hepatic arterial infusion in the treatment ofpostoperative acute liver failure - Basic study on hepatic hemodynamics and clinical application

Aim: In the treatment of severe liver damage, it is of greater advantage to administer prostaglandin E-1 (PGE(1)) directly to the liver compared with systemic intravenous infusion, because of its high inactivation rate in the lungs. In comparison with intraportal infusion, hepatic arterial infusion is more advantageous because of its easier and safer accessibility. This st udy was designed to prove the superiority of hepatic arterial infusion to i ntravenous infusion. Methods: Changes in hepatic hemodynamics and oxygen de livery accompanying PGE(1) infusion using both methods were investigated in pigs, In addition, continuous hepatic arterial infusion was applied in 3 c ases of postoperative acute liver failure, for patients in whom other conve ntional treatments like plasma exchange failed to improve the functioning o f the liver. Results: Hepatic arterial flow increased significantly accompa nying hepatic arterial infusion of PGE(1) at a rate of 0.1 mu g/kg/min comp ared with intravenous infusion at the same rate in pigs, Such an increase r esulted in elevation of total hepatic blood flow and oxygen delivery to the liver. Correspondingly, bile flow significantly increased accompanying hep atic arterial infusion of PGE(1). Continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure. The infusion was c ontinued for 7-9 days at a rate of 0.01 mu g/kg/min without any complicatio ns through heparin-coated catheters inserted via the femoral artery, Signif icant increase in bile flow was observed in 2 cases in whom bile was collec ted, serum total bilirubin began to decrease in all these 3 cases, and the patients recovered from acute liver failure, Conclusion: Hepatic arterial i nfusion of PGE(1) is very useful and effective in the treatment of acute li ver failure. Copyright (C) 2000 S. Karger AG, Basel.