The battle for survival in severe hepatic necrosis with coma is still rarely won, although desperate physicians have resorted to increasingly radical therapeutic measures. Among these have been exchange transfusions, cross-circulation (in some cases with a baboon), peritoneal dialysis and hemodialysis, and more recently, plasmapheresis.
Lepore et al1,2 have described their experience with plasmapheresis as performed with plasma exchange. Arguing that days rather than hours are required for regeneration of damaged liver cells, they regard single or intermittent blood or plasma exchange, with or without plasmapheresis, as doomed to failure. Consequently, they undertook continuous plasmapheresis with plasma exchange,2 a procedure that involves replacing the patient's plasma with fresh-frozen human plasma and returning to him his own red blood cells. Nine patients with acute hepatic necrosis and coma were so treated for periods of 1 to 12 days. Although postmortem evidence suggested hepatocyte regeneration in some cases, even this