AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system(MARS). METHODS:MARS is a liver-assisting device that has been used in the treatmen...AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system(MARS). METHODS:MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery,and as a bridge to liver transplantation(LTX).We analyzed the 1-year outcomes of 188 patients treated with MARS,from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic,clinical and laboratory parameters were recorded before and after each treatment.One-year survival and the number of LTXs were recorded.Logistic regression analysis was performed to determine factors predicting survival. RESULTS:The study included 113 patients with acute liver failure(ALF),62 with acute-on-chronic liver failure(AOCLF),11 with graft failure(GF),and six with miscellaneous liver failure.LTX was performed for 29% of patients with ALF,18% with AOCLF and 55%with GF.The overall 1-year survival rate was 74% for ALF,27% for AOCLF,and 73% for GF.The poorest survival rate,6%,was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis,whereas,patients with enlarged and steatotic liver had 55% survival.The etiology of liver failure was the most important predictor of survival(P<0.0001).Other prognostic factors were encephalopathy(P=0.001)in paracetamol-related ALF, coagulation factors(P=0.049)and encephalopathy(P=0.064)in non-paracetamol-related toxic ALF,and alanine aminotransferase(P=0.013)and factor V levels(P =0.022)in ALF of unknown etiology. CONCLUSION:The etiology of liver disease was the most important prognostic factor.MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.展开更多
BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support thera...BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support therapy as a bridge to re-transplantation in two cases of long anhepatic duration. METHODS: MARS therapy was given after failure plasma- exchange ( PE) treatment, which resulted in circulatory de- rangement and acute renal dysfunction in a 36-year-old male patient. Finally his uncontrolled anhepatic condition led to a successful re-transplantation. In another 48-year- old man who was diagnosed as having primary nonfunction (PNF) during the liver transplantation, 10-hour MARS treatment contributed to smooth bridging of his anhepatic phase. RESULTS: The two anhepatic patients were bridged for 26 and 17 hours respectively to re-transplantation with MARS therapy. CONCLUSION: Our experience proves that MARS artifi- cial liver can be an effective support for long time bridging PNF until re-transplantation is available.展开更多
AIM： To evaluate treatment safety and hemodynamic changes during a single 6-h treatment with the PrometheusTM liver assist system in a randomized, controlled study. METHODS： Twenty-four patients were randomized to e...AIM： To evaluate treatment safety and hemodynamic changes during a single 6-h treatment with the PrometheusTM liver assist system in a randomized, controlled study. METHODS： Twenty-four patients were randomized to either the study group or to one of two control groups： Fractionated Plasma Separation Adsorption and Dialysis, PrometheusTM system （Study group; n = 8）; Molecular Adsorbent Recirculation System （MARS）TM （Control group 1, n = 8）; or hemodialysis （Control group 2; n = 8）. All patients included in the study had decompensated cirrhosis at the time of the inclusion into the study. Circulatory changes were monitored with a Swan-Ganz catheter and bilirubin and creatinine were monitored as measures of protein-bound and water-soluble toxins. RESULTS： Systemic hemodynamics did not differ between treatment and control groups apart from an increase in arterial pressure in the MARS group （P = 0.008）. No adverse effects were observed in any of the groups. Creatinine levels significantly decreased in the MARS group （P = 0.03） and hemodialysis group （P = 0.04）. Platelet count deceased in the Prometheus group （P = 0.04）.CONCLUSION： Extra-corporal liver support with Prometheus is proven to be safe in patients with endstage liver disease but does not exert the beneficial effects on arterial pressure as seen in the MARS group,展开更多
Extracorporeal therapies have a definite role in patients with acute liver failure,acute on-chronic liver failure,and progressive chronic liver disease.They act as a bridge-to-transplant in these patients.With the inc...Extracorporeal therapies have a definite role in patients with acute liver failure,acute on-chronic liver failure,and progressive chronic liver disease.They act as a bridge-to-transplant in these patients.With the increasing success of liver transplantation,the immediate postoperative complication spectrum continues to expand.Extracorporeal therapies can play an important role in managing these complications.However,the literature on extracorporeal therapies in the postliver transplant period is limited.This review article discussed various extracorporeal therapies that are still evolving or marred by limited evidence but can improve patient outcomes.These extracorporeal therapies can be divided into two subgroups:(1)Therapies for infective complications.Endotoxin and cytokine adsorption columns;and(2)Therapies for noninfective complications like small for size syndrome,primary allograft nonfunction,early allograft dysfunction,hyperacute rejection,hepatopulmonary syndrome,etc.(plasma exchange,double plasma molecular adsorption,molecular adsorbent recirculation system,and extracorporeal membrane oxygenation,among others).展开更多
The severity of alcoholic hepatitis(AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalit...The severity of alcoholic hepatitis(AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalities, to severe forms characterised by deep jaundice, ascites, hepatic encephalopathy and low prothrombin index. In hospitalized patients the mortality could be as high as 75%. The elevated number of therapeutic proposals reported for more than forty years reveals the lack of efficacy of a particular modality. Even in the most favorable trials, the survival is already very poor and in some cases related to the development of renal failure or hepatorenal syndrome. There are some motivating reports concerning albumin dialysis as a support treatment in patients with severe AH, either alone or in combination with other pharmacological therapies. The favorable effects of albumin dialysis in patients with severe AH suggest that the procedure used alone or in combination with other therapies may have a role in this clinical condition. This will be particularly relevant to offer an alternative therapy in these patients, thus being a potential bridge to recovery or to be listed for liver transplantation.展开更多
Severe hepatitis is the most severe liver disease, with poor prognosis and high mortality. We explored the practical use of the model for end-stage liver disease （MELD） on clinical and the molecular adsorbents recir...Severe hepatitis is the most severe liver disease, with poor prognosis and high mortality. We explored the practical use of the model for end-stage liver disease （MELD） on clinical and the molecular adsorbents recirculating system （MARS） on chronic severe hepatitis to predict the short-term prognosis of patients with chronic severe hepatitis using the MELD score and the curative effect of MARS treatment.展开更多
基金Supported by A Scientific Grant From the Helsinki University Central Hospital Research Fund(EVO)
文摘AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system(MARS). METHODS:MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery,and as a bridge to liver transplantation(LTX).We analyzed the 1-year outcomes of 188 patients treated with MARS,from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic,clinical and laboratory parameters were recorded before and after each treatment.One-year survival and the number of LTXs were recorded.Logistic regression analysis was performed to determine factors predicting survival. RESULTS:The study included 113 patients with acute liver failure(ALF),62 with acute-on-chronic liver failure(AOCLF),11 with graft failure(GF),and six with miscellaneous liver failure.LTX was performed for 29% of patients with ALF,18% with AOCLF and 55%with GF.The overall 1-year survival rate was 74% for ALF,27% for AOCLF,and 73% for GF.The poorest survival rate,6%,was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis,whereas,patients with enlarged and steatotic liver had 55% survival.The etiology of liver failure was the most important predictor of survival(P<0.0001).Other prognostic factors were encephalopathy(P=0.001)in paracetamol-related ALF, coagulation factors(P=0.049)and encephalopathy(P=0.064)in non-paracetamol-related toxic ALF,and alanine aminotransferase(P=0.013)and factor V levels(P =0.022)in ALF of unknown etiology. CONCLUSION:The etiology of liver disease was the most important prognostic factor.MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.
文摘BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support therapy as a bridge to re-transplantation in two cases of long anhepatic duration. METHODS: MARS therapy was given after failure plasma- exchange ( PE) treatment, which resulted in circulatory de- rangement and acute renal dysfunction in a 36-year-old male patient. Finally his uncontrolled anhepatic condition led to a successful re-transplantation. In another 48-year- old man who was diagnosed as having primary nonfunction (PNF) during the liver transplantation, 10-hour MARS treatment contributed to smooth bridging of his anhepatic phase. RESULTS: The two anhepatic patients were bridged for 26 and 17 hours respectively to re-transplantation with MARS therapy. CONCLUSION: Our experience proves that MARS artifi- cial liver can be an effective support for long time bridging PNF until re-transplantation is available.
基金The NOVO Nordic Foundation, Savvrksejer Jeppe & Ovita Mindelegat, Fabricant Vilhelm Pedersen & Wifes Mindelegat, A.P. Moller Scientific Foundation, the Danish Medical Association Research Fund and the Laerdal Foundation for Acute Medicine, and by an unrestricted grant from the Fresenius Medical Care GmBH
文摘AIM： To evaluate treatment safety and hemodynamic changes during a single 6-h treatment with the PrometheusTM liver assist system in a randomized, controlled study. METHODS： Twenty-four patients were randomized to either the study group or to one of two control groups： Fractionated Plasma Separation Adsorption and Dialysis, PrometheusTM system （Study group; n = 8）; Molecular Adsorbent Recirculation System （MARS）TM （Control group 1, n = 8）; or hemodialysis （Control group 2; n = 8）. All patients included in the study had decompensated cirrhosis at the time of the inclusion into the study. Circulatory changes were monitored with a Swan-Ganz catheter and bilirubin and creatinine were monitored as measures of protein-bound and water-soluble toxins. RESULTS： Systemic hemodynamics did not differ between treatment and control groups apart from an increase in arterial pressure in the MARS group （P = 0.008）. No adverse effects were observed in any of the groups. Creatinine levels significantly decreased in the MARS group （P = 0.03） and hemodialysis group （P = 0.04）. Platelet count deceased in the Prometheus group （P = 0.04）.CONCLUSION： Extra-corporal liver support with Prometheus is proven to be safe in patients with endstage liver disease but does not exert the beneficial effects on arterial pressure as seen in the MARS group,
文摘Extracorporeal therapies have a definite role in patients with acute liver failure,acute on-chronic liver failure,and progressive chronic liver disease.They act as a bridge-to-transplant in these patients.With the increasing success of liver transplantation,the immediate postoperative complication spectrum continues to expand.Extracorporeal therapies can play an important role in managing these complications.However,the literature on extracorporeal therapies in the postliver transplant period is limited.This review article discussed various extracorporeal therapies that are still evolving or marred by limited evidence but can improve patient outcomes.These extracorporeal therapies can be divided into two subgroups:(1)Therapies for infective complications.Endotoxin and cytokine adsorption columns;and(2)Therapies for noninfective complications like small for size syndrome,primary allograft nonfunction,early allograft dysfunction,hyperacute rejection,hepatopulmonary syndrome,etc.(plasma exchange,double plasma molecular adsorption,molecular adsorbent recirculation system,and extracorporeal membrane oxygenation,among others).
文摘The severity of alcoholic hepatitis(AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalities, to severe forms characterised by deep jaundice, ascites, hepatic encephalopathy and low prothrombin index. In hospitalized patients the mortality could be as high as 75%. The elevated number of therapeutic proposals reported for more than forty years reveals the lack of efficacy of a particular modality. Even in the most favorable trials, the survival is already very poor and in some cases related to the development of renal failure or hepatorenal syndrome. There are some motivating reports concerning albumin dialysis as a support treatment in patients with severe AH, either alone or in combination with other pharmacological therapies. The favorable effects of albumin dialysis in patients with severe AH suggest that the procedure used alone or in combination with other therapies may have a role in this clinical condition. This will be particularly relevant to offer an alternative therapy in these patients, thus being a potential bridge to recovery or to be listed for liver transplantation.
文摘Severe hepatitis is the most severe liver disease, with poor prognosis and high mortality. We explored the practical use of the model for end-stage liver disease （MELD） on clinical and the molecular adsorbents recirculating system （MARS） on chronic severe hepatitis to predict the short-term prognosis of patients with chronic severe hepatitis using the MELD score and the curative effect of MARS treatment.
