Traumatic Hepatorenal Failure: Supportive Treatment With Simultaneous Hemodialysis and Exchange Transfusion

Fulminating hepatorenal failure developed in a patient following massive injury to the liver. Simultaneous hemodialysis and exchange transfusion resulted in marked clinical improvement and gained time for recovery of liver and kidney function. Although the patient died of septicemia one month after injury, liver and kidney function just prior to death were adequate. Hemodialysis facilitates exchange transfusion by providing ready access to the circulation and by removing excess blood citrate and stabilizing ionized calcium levels. Removal of urea by dialysis may reduce bacterial ammonia production and enhance recovery from hepatic coma. Elimination of bilirubin and bile acids by exchange transfusion may facilitate recovery of the kidney from acute tubular necrosis. Combined hemodialysis and exchange transfusion appear capable of benefiting patients with hepatorenal syndrome.