1. What are your experience/opinions to initiate/stop DPMAS treatment?
◆ For patients who is not on the waiting list for liver transplantation
1) Patient has an indication for DPMAS, such as liver failure, liver failure tendency or hyperbilirubinemia.
2) Patients should not have contraindications including active bleeding, DIC and etc.
3) The causes of liver failure are well controlled.
When all the above conditions are present, we should start sequential ALSS treatment as soon as possible.
◆ For patient who is on the waiting list for liver transplantation has indications and without contraindication, we would start DPMAS treatment as soon as possible. We would conduct DPMAS treatment even if the causes of liver failure are not under control.
◆ Biomarkers such as PTA and total bilirubin are stable and improved.
◆ Improvement of symptoms.
◆ Re-assess or terminate ALSS treatment when
1) Patient’s condition gets worse
2) Total bilirubin level reaches to the highest level
3) Aggravated complications or develop new complications
In this case, the patient might need liver transplantation for survival. (Dr. Zhou)
2. How do you evaluate the patient before, during and after DPMAS (signs, symptoms, labs)？
3. How do you choose anticoagulant agent？
4. What is the difference between MARS and DPMAS？
5. For ACLF patients who have bilirubin rebound, should I continue or terminate the treatment?