Removal of albumin bound toxins by albumin dialysis improves clinical course of liver cirrhosis complicated by severe cholestasis

Background: Liver Cirrhosis complicated by severe cholestasis (bilirubin > 20 mg/dl) is associated with accumulation of toxic albumin bound substances, like lipophilic bile acids, bilirubin, tryptophane and its metabolites, endogenous vasodilatators like Nitric oxide, prostaglandins, neurotoxins like endogenous benzodiazepines etc. Elevated levels of these substances exhibit toxic effects or/and increase the unbound fraction of other, usually albumin bound toxins, thus creating a cumulative toxic effect on the brain, the kidneys, the cardiovascular system and the liver itself.