The study was conducted in accordance with local Institutional Review Board regulations. We studied the following complications of ALI/ALF: hepatic encephalopathy, infection, systemic inflammatory response, renal failure, thrombosis, and bleeding. These complications were defined as follows: Hepatic encephalopathy was defined and graded according to West Haven criteria.[19]

Infection was defined as a positive urine culture, presence of a pulmonary FXR agonist infiltrate on chest X-ray consistent with infectious etiology, or a positive blood culture not felt to be a contaminant with a skin organism. More than one positive blood culture was required for bacteremia with commensal organisms. Systematic inflammatory response syndrome was defined according to established criteria[20]: white blood cell count >12 or <4 × 109 cells/L, temperature <36°C or >38°C, respiratory rate >20/minutes, and pulse >90 beats per minute. Renal failure was defined as persistent azotemia or oliguria despite rehydration requiring continuous veno-venous hemofiltration. Thrombosis was defined as occlusion of a native blood vessel or indwelling dialysis catheter. When occlusion of a native blood vessel was suspected on clinical grounds, these were confirmed by ultrasound or CT scanning. Bleeding

was defined as the presence of blood per naso-gastric tube, blood per rectum or endotracheal tube, or bleeding at the site of invasive procedure. Final outcomes of ALI/ALF were transplant-free survival, selleck chemicals llc orthotopic liver transplantation, or death. VWF antigen (VWF:Ag) levels were determined with an in-house

enzyme-linked immunosorbent assay (ELISA) assay using commercially available polyclonal antibodies against VWF (DAKO, Glostrup, Denmark). VWF ristocetin cofactor activity (VWF:RCo) was determined using the BC VWF-reagent (Siemens Healthcare Diagnostics) on a Behring Coagulation System (Siemens Healthcare Diagnostics). VWF:Ag and VWF:RCo levels of pooled normal plasma were set at 100% Casein kinase 1 and the values obtained in patient samples were expressed as a percentage of pooled normal plasma. VWF collagen binding activity was determined with an in-house ELISA assay as described.[8] The collagen-binding activity of pooled normal plasma was set at 100% and the activity measured in patient samples was expressed as a percentage of pooled normal plasma. VWF multimer analysis was performed by sodium dodecyl sulfate agarose gel electrophoresis followed by western blotting. The blots were incubated with rabbit anti-VWF antibody (DAKO) and goat anti-rabbit IRDye 800 CW (LI-COR Biosciences, Lincoln, NE). The first five bands were considered as low-molecular weight multimers, whereas other bands were considered as high molecular weight (HMW) multimers. The blots were scanned by the Odyssey Imager (Westburg, Leusden, The Netherlands) and were quantified by morphometric analysis using the ImageScope software package (Aperio, Vista, CA).