Therapeutic plasmapheresis (PP) for liver failure following the resection of primary liver cancer was evaluated retrospectively. PP was repeated two to three times per week using plasma exchange (PE) with fresh frozen plasma as a substitution fluid in all eight cases and direct hemoperfusion (DHP) in two cases. PE effectively decreased serum bilirubin and/or improved hepatic encephalopathy in six of eight patients and prolonged survival time (p less than 0.05, chi-square test). DHP was not effective. Liver failure following the resection of damaged liver differs from acute liver failure in both the condition itself and the reaction to PP. Fractionation of serum bilirubin using high performance liquid chromatography showed differences in the ratio of delta bilirubin in one survivor versus two who died and was effective in selecting a patient who would respond to PE. In conclusion, PE is effective in prolonging survival time after liver failure in hepatectomized patients compared to conventional therapy.