LETTER FROM THE FRONTLINE First Description of Single-Pass Albumin Dialysis Combined With Cytokine Adsorption in Fulminant Liver Failure and Hemophagocytic Syndrome Resulting From Generalized Herpes Simplex Virus 1 Infection

Acute liver failure (ALF) is a rare, life-threatening complication of herpes simplex virus (HSV) infection that can occur in immunocompetent patients. Liver transplantation (LT) is the ultima ratio in cases of ALF that progress despite antiviral treatment. To bridge the time until LT, extracorporeal liver support with the Molecular Adsorbent Recirculating System (MARS; Gambro, Lund, Sweden) has been shown to be a therapeutic option in ALF. Data concerning the use of single-pass albumin dialysis (SPAD) in such cases, however, are scarce. Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome that can occur in many underlying conditions. Animal studies, case reports, and preliminary data from a clinical trial in septic patients have demonstrated that a reduction in blood cytokine levels achieved with an extracorporeal cytokine adsorption cartridge that contains blood-compatible porous polymer beads (CytoSorb, Monmouth Junction, NJ) can effectively attenuate the inflammatory response during sepsis and possibly improve outcomes.