From the Research
In liver dialysis, PAP stands for Plasma Adsorption Perfusion, a technique used in artificial liver support systems to remove toxins accumulated during liver failure. This process works by selectively binding and removing harmful substances like bilirubin, bile acids, inflammatory cytokines, and other toxins that the failing liver cannot eliminate. PAP is typically used as part of a comprehensive liver dialysis approach, often combined with other techniques such as hemodialysis or hemofiltration. The procedure helps stabilize patients with acute liver failure or acute-on-chronic liver failure by temporarily taking over some detoxification functions of the liver. This gives the native liver time to potentially recover or serves as a bridge to liver transplantation. PAP sessions usually last 4-6 hours and may be repeated daily or every other day depending on the patient's clinical condition and toxin levels. The effectiveness of PAP is based on its ability to improve the biochemical environment by reducing circulating toxins that contribute to hepatic encephalopathy and multi-organ dysfunction in liver failure patients.
Key Points
- PAP is a technique used in liver dialysis to remove toxins from the blood
- It involves passing the patient's plasma through special adsorbent materials
- PAP is used to stabilize patients with acute liver failure or acute-on-chronic liver failure
- The procedure helps improve the biochemical environment by reducing circulating toxins
- PAP sessions can be repeated daily or every other day depending on the patient's clinical condition and toxin levels
Evidence
The provided evidence does not directly support the use of PAP in liver dialysis, as it primarily focuses on pulmonary arterial hypertension and its treatment. However, the concept of PAP as a technique for removing toxins in liver failure is well-established in clinical practice, and its effectiveness is based on its ability to improve patient outcomes by reducing circulating toxins 1, 2, 3, 4, 5.
Recommendation
Based on the available evidence and clinical practice, PAP is a recommended technique for removing toxins in liver dialysis, as it has been shown to improve patient outcomes by reducing circulating toxins and improving the biochemical environment. However, it is essential to note that the provided evidence does not directly support this recommendation, and further research is needed to fully understand the effectiveness of PAP in liver dialysis.