1184 Extracorporeal Liver Support With the Molecular Adsorbent Recirculating System (Mars) in Patients With Acute-on-Chronic Liver Failure (Aoclf). The Relief Trial

Bañnares, R.; Nevens, Frederik; Larsen, F.S.; Jalan, Rajiv; Albillos, A.; Dollinger, Matthias

doi:10.1016/s0168-8278(10)61185-3

Cited by 53 publications

(44 citation statements)

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“…Growing attention has focused on these devices to treat specific conditions, such as severe jaundice or pruritus, or bridge patients with acute-on-chronic liver failure to OLT [62,63]. However, while it is undisputed that these devices can efficiently, but often transiently, lower at least one of the triad parameters included in the MELD score, i.e.…”

Section: Acute Complications Of Cirrhosis and The Use Of Artificial Lmentioning

confidence: 99%

The MELD score in patients awaiting liver transplant: Strengths and weaknesses

Bernardi

Gitto

Biselli

2011

Journal of Hepatology

148

127

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Adoption of the Model for End-stage Liver Disease (MELD) to select and prioritize patients for liver transplantation represented a turning point in organ allocation. Prioritization of transplant recipients switched from time accrued on the waiting list to the principle of "sickest first". The MELD score incorporates three simple laboratory parameters (serum creatinine and bilirubin, and INR for prothrombin time) and stratifies patients according to their disease severity in an objective and continuous ranking scale. Concordance statistics have demonstrated its high accuracy in stratifying patients according to their risk of dying in the short-term (three months). Further validations of MELD as a predictor of survival at various temporal end-points have been obtained in independent patient cohorts with a broad spectrum of chronic liver disease. The MELD-based liver graft allocation policy has led to a reduction in waitlist new registrations and mortality, shorter waiting times, and an increase in transplants, without altering overall graft and patient survival rates after transplantation. MELD limitations are related either to the inter-laboratory variability of the parameters included in the score, or to the inability of the formula to predict mortality accurately in specific settings. For some conditions, such as hepatocellular carcinoma, widely accepted MELD corrections have been devised. For others, such as persistent ascites and hyponatremia, attempts to improve MELD's predicting power are currently underway, but await definite validation.

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Section: Acute Complications Of Cirrhosis and The Use Of Artificial Lmentioning

confidence: 99%

The MELD score in patients awaiting liver transplant: Strengths and weaknesses

Bernardi

Gitto

Biselli

2011

Journal of Hepatology

148

127

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“…Such systems, currently available only in specialized and transplant centers, have a potential therapeutic role in the following medical conditions: Acute fulminant liver failure, acute liver failure on chronic liver disease, primary dysfunction of the transplanted liver, liver failure after resection and intractable pruritus [37]. It has to be stressed, however, that the results of the fi rst large-scale controlled trials that have employed either MARS or Prometheus in patients with cirrhosis and acute-onchronic liver failure did not show a signifi cant impact on major outcomes, such as survival [38,39]. Likely, subgroups of patients who would actually benefi t from these detoxifi cation systems need to be identifi ed, as suggested by the survival benefi t observed in patients with severe cirrhosis (model for end-stage liver disease [MELD] score > 30) and HRS type 1 treated with the Prometheus system [39].…”

Section: Non-oncotic Properties Of Albumin In Cirrhosismentioning

confidence: 99%

Human Albumin in the Management of Complications of Liver Cirrhosis

Bernardi¹,

Maggioli²,

Zaccherini³

2012

Annual Update in Intensive Care and Emergency Medicine 2012

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“…Owing to the aforementioned controversies, all hope was put on the concurrent multicenter randomized controlled trials with either MARS (RELIEF) trial MARS therapy of up to ten sessions of 6-8 h vs standard medical therapy. The trail enrolled 189 patients and had an average MELD of 28 [105]. The second randomized contraolled trail (HELIOS) investigated Prometheus therapy of up to 11 treatments of minimal 4 h versus standard medical therapy.…”

Section: Clinical Impact Of Liver Support On Survivalmentioning

confidence: 99%