The most serious hepatic complication after
surgical procedure is postoperative
hepatic failure. There is no
therapy for this condition except
plasma exchange. Precise clinical definition of postoperative
hepatic failure was discussed based on a questionnaire distributed by the association in 1989, and in 1991 by the working group. Giving special consideration to the use of
therapeutic plasmapheresis, the clinical definition of postoperative
hepatic failure was established as hepatic injury after surgery, without obstructive causative factors, laboratory values for total
bilirubin over 5mg/dl with continuous elevation, and
hepaplastin activity under 40%. Key factors in determining initiation, efficacy, and cessation of
plasmapheresis were
coma grade (II-III), total
bilirubin levels, and the activities of coagulation tests. The majority of underlying diseases were hepato-biliary in nature. The causative factors of hepatic
injuries were massive
bleeding and
infection. The morbidity was estimated at 600 to 3000 cases/year. The frequency of
plasma exchange was one session every/1.4-1.6 days. The volume of exchanged fresh frozen plasma was about 3292 ml/a session.
Nafamostat mesilate was used as an
anticoagulant. The survival rate was 14% to 40%. Earlier initiation of
plasma exchange is indicated.