Role of Albumin Peritoneal Dialysis for Bilirubin Removal after Complicated Liver Transplant

Background: Hyperbilirubinemia has been implicated to have nephrotoxic and hepatotoxic effects. Thus, removal of excessive bilirubin in patients with severe jaundice and renal failure could potentially benefit the recovery of hepatic and renal function. In experimental animal and anecdotal reports in humans, albumin containing peritoneal dialysis (PD) maybe successful in removing bilirubin. Methods: We utilized albumin-enriched (4 8.4 g/L) PD in a patient with primary hepatic allograft dysfunction with severe jaundice and renal failure. Results: Plasma and peritoneal concentrations of bilirubin (total/direct) before initiation of PD were 23.9 / 14.8 mg/dl and 4.1/ 2.5 mg/dl, respectively. After addition of 8.4 g of albumin / L of PD fluid, the concentrations were 32.4 / 21.3 mg/dl and 0.1 / 0.1 mg/dl, respectively. Conclusions: There was no significant benefit of this therapy in improving hyperbilirubinemia. However, a higher concentration of albumin in PD fluid might have been more effective.