A comparison among three different apheretic techniques for treatment of hyperbilirubinemia

Viggiano, Davide; Pascale, E. de; Marinelli, Gaia; Pluvio, C.

doi:10.1007/s10047-017-0986-1

Cited by 11 publications

(15 citation statements)

References 31 publications

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“…Another pump pushes the plasma into a cartridge with adsorptive properties, after this passage, both circuit limbs converge into the same deaeration chamber, finally returning to the patient. 36 The cartridge has a styrene-divinylbenzene resin that binds electrostatically to bilirubin and bile acids in a selective manner. This discriminative ability relies on the size of the pores in the resin, 30-40 nm.…”

Section: Pl a S Ma Adsorp Ti On Perfus I Onmentioning

confidence: 99%

“…[33][34][35] On day 9, 24-h urine output was 2200 mL, factor V was 35%, total bilirubin 21 mg/dl, vasopressors were weaned and CRRT was stopped. Plasma adsorption perfusion (PAP) was applied to further reduce bilirubin concentration 36,37 and consequently renal tubular toxicity 38 as the patient was not on CRRT at this point. After three consecutive PAP sessions, total bilirubin was 11 mg/dl.…”

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confidence: 99%

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Continuous renal replacement therapy and extended indications

Ronco

Reis

2021

Seminars in Dialysis

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Initially developed to replace kidney function in severely ill newborns/infants, and then diverted to severely ill adult patients, 1 continuous renal replacement therapy (CRRT) is now applied to support different organs apart from the kidney in a myriad of clinical conditions such as sepsis, 2 acute liver failure (ALF), 3 acute respiratory distress syndrome (ARDS), 4-6 and cardiogenic shock. 7 The extended indications for CRRT and the concept of sequential extracorporeal therapies 8 are intrinsically related. The individualization of care and selection of treatment candidates based on clinical and molecular phenotypes increases the probability of benefit for each of the proposed blood purification techniques 9-15 (Figure 1).In sepsis, the removal of damage-associated molecular patterns (e.g. cytokines) and pathogen-associated molecular patterns (e.g. endotoxins) might reduce the burden of the disease. 16 In liver failure, CRRT reduces the risk of ammonia-related neurotoxicity while artificial liver support systems effectively reduce bilirubin and bile acids concentrations. 3 In ARDS, extracorporeal CO 2 removal (ECCO 2 R) allows the application of ultra-protective ventilation avoiding deleterious consequences of hypercapnia and reducing the risk of ventilator-associated lung injury. [17][18][19] In cardiogenic shock and cardiac surgery in which shifts in fluid balance are poorly tolerated, CRRT might mitigate further myocardial damage. 20,21

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Section: Pl a S Ma Adsorp Ti On Perfus I Onmentioning

confidence: 99%

mentioning

confidence: 99%

Continuous renal replacement therapy and extended indications

Ronco

Reis

2021

Seminars in Dialysis

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“…Some other modification techniques such as plasma diafiltration, plasma exchange, or therapeutic apheresis using a bilirubin adsorbent column were also published in literature anecdotally [51][52][53].…”

Section: Other Devicesmentioning

confidence: 99%

Liver Assist Devices for Liver Failure

Mandal¹,

Garlapati²,

Tiongson³

et al. 2021

Liver Pathology

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Historically, mortality rates for liver failure have been high, regardless of the type. With new advancements in liver transplantation (LTx), 1-year survival rates have improved up to 95% in most recent estimates. While some patients may live past the critical period, the majority of patients do not survive the interval period for awaiting LTx or liver regeneration. The function of the liver to detoxify and correct several biochemical parameters has been achieved to some extent through artificial liver support technology, although constant innovations are still being developed for the most optimal liver support device. The complex function of the liver makes it challenging since it does not only detoxify toxic by-products but also participates in numerous other synthetic and metabolic functions of the body. Liver support systems are divided into an artificial liver assist device (ALD) and a bioartificial liver assist device (BLD). ALDs include molecular adsorbent recirculating system (MARS), Prometheus, single-pass albumin dialysis, and selective plasma filtration therapy. These devices work as a blood purification system of the liver. On the other hand, BLD has hepatic cell lines incorporated in its equipment, which aims to function as a complex biological liver system providing support to its biochemical processes. Several clinical and randomized trials have conflicting results on the survival of the patients with acute liver failure (ALF), and the ideal liver support system still seems a far-off goal.

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“…Some modifications of the techniques described above, such as plasma diafiltration and some protocols already used several years ago to treat liver failure, such as plasma exchange or therapeutic apheresis using a bilirubin adsorbent column, are also found anecdotally in the literature [ 43 , 92 , 93 ].…”

Section: Other Devicesmentioning

confidence: 99%

Artificial liver support systems: what is new over the last decade?

Martínez

Bendjelid

2018

Ann. Intensive Care

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The liver is a complex organ that performs vital functions of synthesis, heat production, detoxification and regulation; its failure carries a highly critical risk. At the end of the last century, some artificial liver devices began to develop with the aim of being used as supportive therapy until liver transplantation (bridge-to-transplant) or liver regeneration (bridge-to-recovery). The well-recognized devices are the Molecular Adsorbent Recirculating System™ (MARS™), the Single-Pass Albumin Dialysis system and the Fractionated Plasma Separation and Adsorption system (Prometheus™). In the following years, experimental works and early clinical applications were reported, and to date, many thousands of patients have already been treated with these devices. The ability of artificial liver support systems to replace the liver detoxification function, at least partially, has been proven, and the correction of various biochemical parameters has been demonstrated. However, the complex tasks of regulation and synthesis must be addressed through the use of bioartificial systems, which still face several developmental problems and very high production costs. Moreover, clinical data on improved survival are conflicting. This paper reviews the progress achieved and new data published on artificial liver support systems over the past decade and the prospects for these devices.

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A comparison among three different apheretic techniques for treatment of hyperbilirubinemia

Cited by 11 publications

References 31 publications

Continuous renal replacement therapy and extended indications

Continuous renal replacement therapy and extended indications

Liver Assist Devices for Liver Failure

Artificial liver support systems: what is new over the last decade?

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