Plasmapheresis with Plasma Exchange in Hepatic Coma

Five patients with acute fulminant hepatic necrosis with coma were subjected to vigorous, massive, and prolonged plasmapheresis with plasma exchange on the theory that removal of the patient's plasma would eliminate or reduce circulating noxious protein-bound factors responsible for coma and that replacement of the patient's plasma with fresh frozen human plasma would support the patient through the critical period required for hepatocyte regeneration. One of the five patients emerged from stage IV coma on day 6 and another on day 8 of vigorous plasmapheresis and appeared to be recovering until severe and relentless bronchopneumonia led to their deaths. The technique can be conducted in humans without undue risk and is more practicable and more in keeping with the pathology of hepatic necrosis than pig liver bypass, human cadaver liver bypass, or cross-circulation with humans, baboons, or chimpanzees.