Fibronectin replacement in patients with fulminant hepatic failure

Patients with fulminant hepatic failure have low levels of the plasma opsonizing protein fibronectin together with cardiovascular disturbances similar to those in septic shock where microembolization of capillary beds by particulate debris has been proposed to lead to multi-organ failure. Six patients with fulminant hepatic failure received a bolus injection of a concentrated fibronectin-rich preparation. The mean plasma immunoreactive fibronectin level increased from 53 +/- SE 12 micrograms ml-1 initially to 295 +/- 30 micrograms ml-1 (P less than 0.001) at 1 h after fibronectin administration. The in vitro plasma opsonic activity was also increased from 5.6 +/- 3.6% of control to 102 +/- 13% (P less than 0.005) at 1 h. No similar effect was observed with the clearance of microaggregated albumin, but as its clearance is probably not dependent on fibronectin it may reflect a different aspect of reticuloendothelial cell function. No significant changes were observed in cardiopulmonary function or oxygen utilization and it is possible this is because clearance of opsonized particles is limited by damage to Kupffer cells.