Albumin dialysis with molecular adsorbent recirculating system (MARS) for the treatment of hepatic encephalopathy in liver failure

Kobashi-Margáin, Ramón A.; Gavilanes-Espinar, Juan G; Gutiérrez-Grobe, Ylse; Gutiérrez-Jiménez, A.A.; Chávez-Tapia, Norberto C.; Ponciano-Rodríguez, Guadalupe; Uribe, Misael; Sánchez, Nahum Méndez

doi:10.1016/s1665-2681(19)31611-4

Cited by 21 publications

(10 citation statements)

References 28 publications

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“…Previous studies have demonstrated that a reduction in blood ammonia levels improves hepatic encephalopathy, neuropsychological test performance, cognitive function, and health-related quality of life [3]. Lactulose, an ammonia absorption minimizer, has been successfully used to reduce blood ammonia levels in minimal hepatic encephalopathy.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy

Chavez-Tapia

Cesar-Arce

Barrientos‐Gutiérrez

et al. 2013

Nutr J

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Background and aimBecause low serum zinc levels precipitate hepatic encephalopathy, zinc supplementation is considered a potential therapeutic option. The aim of this study was to assess the effects of oral zinc supplementation in the treatment of hepatic encephalopathy.MethodsFor this systematic review and meta-analysis, data sources included electronic databases (CENTRAL, MEDLINE, EMBASE) and manual searching. Randomized clinical trials of adult patients diagnosed with liver cirrhosis and hepatic encephalopathy were included. The types of interventions considered were any oral zinc supplementation versus no intervention, placebo, or other interventions for the management of hepatic encephalopathy. The data were analyzed by calculating the RR for each trial and expressing the uncertainty as 95% CI. Continuous data were analyzed by calculating the standard mean differences (SMD) between groups within each trial and their 95% CI. Statistical heterogeneity was defined as a P-value > 0.10 (χ2) or I2 > 25%.ResultsFour trials with a total of 233 patients were included. Oral zinc supplementation was associated with a significant improvement in performance on the number connection test (SMD –0.62; 95% CI –1.12 to –0.11) reported in three trials (n = 189), but not with encephalopathy recurrence reduction (RR 0.64; 95% CI 0.26 to 1.59) reported in two trials (n = 169). Other clinically significant outcomes (mortality, liver related morbidity, quality of life) were not reported.ConclusionOral zinc supplementation improved performance on the number connection test, but no evidence about other clinical or biochemical outcomes was available.

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Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy

Chavez-Tapia

Cesar-Arce

Barrientos‐Gutiérrez

et al. 2013

Nutr J

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“…One major limitation concerns the current lack of clinical treatment alternatives in the context of the early identification of risk for PHI. It is possible that as bridging treatments such as molecular adsorbent recirculating systems and plasma separation and filtration are developed for the injured liver, the early identification of these patients may become more clinically relevant and time‐sensitive because a therapeutic option to improve liver function or support the body while the liver recuperates can be provided . Other limitations include the retrospective method of analysis, which limits the interpretation of causality between predictors and outcomes and suggests only association.…”

Section: Discussionmentioning

confidence: 99%

Early identification of patients at increased risk for hepatic insufficiency, complications and mortality after major hepatectomy

Etra

Squires

Fisher

et al. 2014

HPB

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“…Animal studies have demonstrated a decrease in intracranial pressure after treatment with FPSA [14]. A favorable shift in the amino acid profile toward branched chain amino acids, reduction in plasma ammonia levels and oxygen saturation of jugular venous bulb blood (SjVO 2 ) have also been reported [15,16].…”

Section: Hepatic Encephalopathy In Aclfmentioning

confidence: 98%

Liver dialysis in acute-on-chronic liver failure: current and future perspectives

et al. 2014

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Patients with acute-on-chronic liver failure (ACLF) are known to have a very high mortality rate as the majority of these patients succumb to multiorgan failure. Liver transplant remains the only option for these patients; however, there are problems with its availability, cost and also the complications and side effects associated with immunosuppression. Unlike advanced decompensated liver disease, there is a potential for hepatic regeneration and recovery in patients with ACLF. A liver support system, cell or non-cell based, logically is likely to provide temporary functional support until the donor liver becomes available or the failing liver survives the onslaught of the acute insult and spontaneously regenerates. Understanding the pathogenesis of liver failure and regeneration is essential to define the needs for a support system. Removal of hepatotoxic metabolites and inhibitors of hepatic regeneration by liver dialysis, a non-cell-based hepatic support, could help to provide a suitable microenvironment and support the failing liver. The current systems, i.e., MARS and Prometheus, have failed to show survival benefits in patients with ACLF based on which newer devices with improved functionality are currently under development. However, larger randomized trials are needed to prove whether these devices can enable restoration of the complex dysregulated immune system and impact organ failure and mortality in these patients.

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Albumin dialysis with molecular adsorbent recirculating system (MARS) for the treatment of hepatic encephalopathy in liver failure

Cited by 21 publications

References 28 publications

A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy

A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy

Early identification of patients at increased risk for hepatic insufficiency, complications and mortality after major hepatectomy

Liver dialysis in acute-on-chronic liver failure: current and future perspectives

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