**13. Hemoperfusion**

There are many reports of the use of hemoperfusion in liver failure since the 70s and 80s.

Hemoperfusion is an extracorporeal therapy technique, which allows the passage of blood through a filter with the adsorption capacity of molecules with molecular weights from 5 to 50 kD, and the cartridges are classified according to a) composition in natural compounds (carbons) and synthetics (divinylbenzene), b) surface and volume, c) size, and d) selectivity.

The adsorption mechanisms attract solutes through different forces (hydrophobic interactions, ionic attraction, hydrogen bonding, and Van der Waals interactions), which allow the uptake of PAPMs, DAMPs, cytokines, chemokines, and multiple toxic substances (drugs, poisons).

*Artificial Liver Support Systems DOI: http://dx.doi.org/10.5772/intechopen.109843*

#### **Figure 12.**

*Hemoperfusion. It is an adsorptive therapy that uses activated carbon cartridges or divinylbenzene resins.*

The cartridges can be mounted in CRRT or in an intermittent hemodialysis (IH) machine, and it can be coupled to CRRT, prolonged intermittent renal replacement therapy (PIRRT), or IH modalities, to simultaneously perform both therapies (**Figure 12**).

In a retrospective study [55], the use of charcoal hemoperfusion in 13 patients with refractory pruritus in cholestatic, managed to reduce pruritus in 69% of patients and in a numerical pruritus score performed before the start of therapy with a score of 9/10, decreased to 4/10, with an average of 5 sessions.

Stanje J et al. [56], in an *in vitro* two-compartment model established for the comparison of MARS vs. Cytosorb, water-soluble toxicants, such as creatinine, decreased significantly with MARS (p = < 0.04), and the decrease in ammonia was more significant with Cytosorb (p = < 0.05). Regarding the toxins bound to albumin, Cytosorb managed to decrease the values of total and indirect bilirubin in statistically significant values (p = < 0.03) and the elimination of bile acids was comparable. The decrease in cytokines, such as IL-6 and TNF-α with 6 hours of therapy, was significant with Cytosorb. More controlled studies are required to support the results reported in experimental studies and case series.
