Prostaglandin E1 Continuous Hepatic Arterial Infusion in the Treatment of Postoperative Acute Liver Failure

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Abstract
Aim: In the treatment of severe liver damage, it is of greater advantage to administer prostaglandin E1 (PGE1) 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 study was designed to prove the superiority of hepatic arterial infusion to intravenous infusion. Methods: Changes in hepatic hemodynamics and oxygen delivery accompanying PGE1 infusion using both methods were investigated in pigs. In addition, continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure, for patients in whom other conventional treatments like plasma exchange failed to improve the functioning of the liver. Results: Hepatic arterial flow increased significantly accompanying hepatic arterial infusion of PGE1 at a rate of 0.1 μg/kg/min compared with intravenous infusion at the same rate in pigs. Such an increase resulted in elevation of total hepatic blood flow and oxygen delivery to the liver. Correspondingly, bile flow significantly increased accompanying hepatic arterial infusion of PGE1. Continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure. The infusion was continued for 7–9 days at a rate of 0.01 μg/kg/min without any complications through heparin-coated catheters inserted via the femoral artery. Significant increase in bile flow was observed in 2 cases in whom bile was collected, serum total bilirubin began to decrease in all these 3 cases, and the patients recovered from acute liver failure. Conclusion: Hepatic arterial infusion of PGE1 is very useful and effective in the treatment of acute liver failure.
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