Four patients with fulminant hepatic necrosis and coma were treated with daily 10-liter plasma exchanges for periods of 3 to 36 days. Three of the patients recovered. Two of the four patients developed acute pulmonary edema not attributable to volume overload on two and four occasions during or following exchange.
One of the three surviving patients was in coma for 37 days. In 12 to 16 months of follow-up, all three patients showed evidence of further active hepatic disease. In two, this was a single mild episode at 70 and 56 days after plasma exchange. In the third patient, followed up for 27 months, there have been continuing episodes of mild, active hepatitis.