Use of Hemoadsorption in a Case of Severe Hepatic Failure and Hyperbilirubinemia.

Case presentation • Medical history included lymphoblastic lymphoma, morbid obesity (BMI 43), steatohepatitis, arterial hypertension, renal cysts, and laparoscopic cholecystectomy • Laboratory testing revealed significantly elevated transaminases (GOT 241 U/L, GPT 196 U/L) as well as increased total bilirubin serum levels (2.3 mg/dL), while retention parameters were within the normal range • In the further course, active hepatitis B was diagnosed (viremia >100,000 copies/mL) and therapy with entecavir was initiated • At this time, bilirubin levels reached 39.5 mg/dL, GOT 988 U/L, and GPT 792 U/L • On day 9 after admission, the patient developed acute kidney injury (oliguria <0.2 mL/kg/h, creatinine 2.79 mg/ dL, KDIGO level 3) and was admitted to the intensive care unit for escalation of therapy (application of maximum therapy, advanced monitoring and use of extracorporeal organ support) • In order to rebalance the excessive hyperbilirubinemia, hence to salvage kidney function, CVVH and CytoSorb were also initiated in combination