Albumin dialysis using the molecular adsorbent recirculating system

Abstract

Liver support systems based on either dialysis, filtration, and adsorption or plasmaperfusion over hepatocytes have been tested clinically with varying success. A new approach in this field is the selective removal of albumin-bound end products of metabolism. This can be achieved in a high-flux dialysis setting by the addition of human serum albumin as a molecular adsorbent to the dialysate with subsequent recirculation of the dialysate over sorbents (molecular adsorbent recirculating system). The current knowledge about the albumin dialysis molecular adsorbent recirculating system is reviewed in this article.

Effect of molecular adsorbent recirculating system in hepatitis C virus-related intractable pruritus

“…This effects the removal of such albuminbound toxins as aromatic amino acids, bilirubin, bile acids, phenols, short-and middle-chain fatty acids, and copper, together with such free solutes as ammonia, creatinine, and urea that are removed by standard dialysis. 1,2,5,6 MARS has shown specific efficacy in the treatment of acute-on-chronic hepatic failure, [7][8][9][10][11] in which it improves cerebral blood flow; hemodynamic, liver, and renal function; coagulation; and survival. [7][8][9][10][11][12][13] Although pruritus has been described as a possible presenting symptom for hepatitis C virus (HCV)-and/or chronic hepatitis-related cirrhosis, it is considered a rare finding in this setting.…”

“…16 However, poor health-related quality of life and possible significant psychological disturbances causing sleep deprivation, depression, and suicidal ideas 16,20,21 might justify, in the most severe cases of intractable pruritus, more aggressive treatment, including liver transplantation, 22 charcoal hemoperfusion, and the recently introduced MARS. 10,[23][24][25] Of note, the effect of MARS on hydrophobic and hydrophilic bile acids has never been differentiated. However, because of the ability of MARS to combine albumin and standard dialysis, the system should be able to remove both forms of acids, at least theoretically.…”

“…However, because of the ability of MARS to combine albumin and standard dialysis, the system should be able to remove both forms of acids, at least theoretically. 1 10 and 74. The higher the score, the better the quality of life.…”

Falla hepática aguda sobre crónica

“…Estos disacáridos cortan las cadenas de los ácidos grasos con la ayuda de la flora bacteriana del colon, logrando así una acidificación del medio; el aumento de hidrógenos favorece la conversión de amonio en una molécula no absorbible, amoníaco. La administración puede ser oral o rectal (enemas) (34,35).…”

Present and Future Developments in Hepatic Tissue Engineering for Liver Support Systems

“…From a medical point of view, the purely detoxifying and filtrating capacity of anorganic devices has been a relevant addition to the treatment regimens. Apart from charcoal-and polymer-based regimens, the use of albumin as a carrier and shuttle molecule was also proven to be a successful treatment option, which is currently in widespread use, such as the molecular adsorbent recirculation system (MARS) (Mitzner et al 2001) and the more recent addition to the field, namely the Prometheus system (Evenepoel et al 2005). Both systems replace the detoxification function of the liver by removing of a number of toxins.…”