Biocompatibility of a cuprophane charcoal-based detoxification device in cirrhotic patients with hepatic encephalopathy

Extracorporeal detoxification has been proposed to treat patients with hepa tic encephalopathy (HE) not responding to standard therapy. To investigate the biocompatibility of a cuprophane charcoal-based detoxification device, a prospective, randomized, controlled study was performed. Of 41 consecutiv e patients with cirrhosis and HE grade II or III who did not improve with c onventional treatment, 20 patients (median age, 56 years; range, 33 to 71 y ears; 13 men) were randomly assigned to either ongoing conventional treatme nt or one additional 6-hour treatment with a sorbent suspension dialysis sy stem. Main outcome parameters were physiological function and blood paramet ers of biocompatibility. In the 10 patients undergoing combined conventiona l and sorbent suspension dialysis treatment, blood pressure remained unchan ged and body temperature and heart rate increased (P < 0.01). Platelet coun t decreased (medians, from 75 to 26 g/L; P < 0.001) and international norma lized ratio increased after combined treatment (2.0 to 2.2; P < 0.001). Thr ee patients developed bleeding complications during treatment or shortly af ter. Treated patients showed increases in levels of plasma elastase (104 to 586 <mu>g/L; P = 0.001), tumor necrosis factor-alpha (5.4 to 7.5 pg/mL; P = 0.04), and interleukin-6 (118 to 139 pg/mL; P = 0.04), but not interferon -gamma and E-selectin. No changes were observed in the 10 patients treated conventionally. In conclusion, despite technical refinements compared with charcoal hemoperfusion, biocompatibility of sorbent suspension dialysis is still very limited. Clinical complications were apparently caused by blood- membrane interactions and disseminated intravascular coagulation. We sugges t further developments in design and appropriate strategies of anticoagulat ion to improve the biocompatibility of artificial liver support. (C) 2000 b y the National Kidney Foundation, Inc.