Prostaglandin E1 (
PGE1) has received attention for its protective effects against various types of liver damage. However, it is known that approximately 70% of
PGE1 is inactivated during a single passage through the lung. Therefore, direct infusion of
PGE1 into the liver bloodstream is preferable to
intravenous infusion. A 66-year-old man with
hepatocellular carcinoma with
liver cirrhosis developed postoperative
acute liver failure following posterior
segmentectomy under hepatic total vascular exclusion exceeding 1 hour. Because his liver function did not recover in spite of
plasma exchange starting on postoperative day 8 and
intravenous infusion of
PGE1, hepatic arterial continuous infusion of
PGE1 at a rate of 0.01 microgram/kg/min was carried out for 7 days from postoperative day 17. Immediately after the start of the arterial infusion, the bile flow significantly increased compared to before the arterial infusion, and the serum total
bilirubin level decreased thereafter and finally recovered from the
hepatic failure. In addition to its highly efficient
drug delivery, the hepatic arterial infusion of
PGE1 seems to be more advantageous in
oxygen delivery to the liver compared with
intravenous infusion. In conclusion, the hepatic arterial infusion of
PGE1 may be useful in the treatment of
acute liver failure.