Changes of serum bilirubin fraction in postoperative liver failure cases treated by plasmapheresis: an effective marker for evaluation of bilirubin removal.

Utility of a new method of bilirubin fractionation was evaluated in monitoring the effectiveness of plasma exchange (PE) performed in 10 postoperative cases with liver failure. Fractionation of serum bilirubin by high-performance liquid chromatography demonstrated a higher delta bilirubin (B delta) peak against lower conjugated bilirubin peaks [monoconjugated bilirubin (MCB) and diconjugated bilirubin (DCB)] in the three recovered cases. The calculated ratio of MCB/B delta and the ratio of B delta/(MCB + DCB + B delta) in the recovered cases showed statistically significant different against seven unrecovered cases (p less than 0.01). These results suggest that the recovered cases had a different quality hyperbilirubinemia and a different disease entity before PE as well as a different response to PE, and this novel method for serum bilirubin subfraction is considered a useful marker in selecting a patient responsive to PE.