Albumin Regeneration in Liver Support—Comparison of Different Methods

Mitzner, Steffen; Klammt, Sebastian; Stange, Jan; Schmidt, R.

doi:10.1111/j.1744-9987.2006.00351.x

Cited by 57 publications

(40 citation statements)

References 43 publications

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“…Conventional dialytic therapies do not remove proteinbound substances, such as non-ceruloplasmin-bound copper. Since albumin has specific binding sites for metals such as copper [4], albumin dialysis may allow for the increased clearance of non-ceruloplasmin-bound copper in fulminant Wilson disease.…”

Section: Introductionmentioning

confidence: 99%

Single pass albumin dialysis (SPAD) in fulminant Wilsonian liver failure: a case report

et al. 2008

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Since fulminant Wilsonian liver failure has an extremely poor prognosis, the use of a liver support system that can bridge patients to liver transplant is life saving. We report here the case of a 17-year-old female who presented with fulminant Wilsonian liver failure and intravascular hemolysis. With the subsequent development of encephalopathy and oliguria, single pass albumin dialysis (SPAD) was initiated for 5 days to augment copper removal. Continuous venovenous hemodialysis (CVVHD) was performed using the PRISMA machine, with a blood flow of 100 ml/min and a dialysate flow of 2 L/h for 8 h, then 1 L/h. A 5% albumin dialysate was made by exchanging 1 L of 25% albumin for 1 L of Hemosol BO in a 5-L bag. Single pass albumin dialysis resulted in reductions in serum copper (154 to 59 microg/dL), conjugated bilirubin (37 to 23 mg/dL), lactate dehydrogenase (1305 to 729 units/L), and creatinine (1.1 to 0.9 mg/dL) as well as reduced blood transfusion requirements. Cessation of SPAD was followed by three plasmapheresis treatments for further copper removal. We conclude that SPAD is potentially an effective treatment in fulminant Wilson disease with hemolysis but that it should be used in combination with chelation to optimize the removal of copper.

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Section: Introductionmentioning

confidence: 99%

Single pass albumin dialysis (SPAD) in fulminant Wilsonian liver failure: a case report

et al. 2008

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“…Albumin is the most abundant human plasma protein and is an important transporter of hydrophobic internal and external substances. Liver failure results in decreased albumin-binding capacity because of decreased hepatic synthesis [10]. Albumin level during admission might reflect hepatic synthetic capacity and was a prognostic factor in patients with type 1 HRS.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal assessment of prognostic factors for patients with hepatorenal syndrome in a tertiary center

Yang

et al. 2010

Hepatol Int

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Introduction Hepatorenal syndrome (HRS) is one of the serious complications in patients with advanced cirrhosis and ascites. In tertiary centers, most patients were classified as having type 1 HRS for their rapid progressive diseases. However, no significant predictors have been assessed previously for patients with type 1 HRS. In addition to the initial model of end-stage liver disease (MELD) scores and biochemistry parameters, we want to further investigate the prognostic importance of changes in MELD scores and biochemistry parameters over time for patients with type 1 HRS. Materials and methods Data from type 1 HRS patients were incorporated, including their demographic, clinical progression, all recording biochemical parameters, therapeutic methods, and outcomes. Results A total of 103 patients were included in our study. According to the definition of the International Ascites Club, 67 patients (or 65%) had type 1 HRS whereas 36 (or 35%) had type 2 HRS. According to the multivariate COX proportional hazards regression model, either initial biochemistry parameters or MELD scores were not significantly associated with prognosis. By time-dependent proportional hazards model, each point elevated in creatinine (CRE) and total bilirubin (TBI) levels during the admission increased mortality risk by 29 and 4%, respectively. Increasing albumin level during the admission showed its protective value. Changes in MELD score simple during the admission, which were calculated by CRE and TBI [3.8 9 log (bilirubin (mg/dl)] ? 9.6 9 log [Creatinine (mg/dl) ? 6.43], were significant predictor for patients with type 1 HRS. Conclusion In patients with type 1 HRS, changes in TBI, CRE, and albumin level during the admission were associated with prognosis. Changes in MELD score simple is superior to initial and changes in MELD scores to predict prognosis in patients with type 1 HRS.

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“…Unlike MARS, where the albumin solution is regenerated by removing protein-bound substances through an activated charcoal column and an anion exchange resin, the albumin dialysate in SPAD is discarded after a single pass, necessitating a large supply of albumin [8]. One strategy to conserve albumin and limit the cost of SPAD would be to reduce the clearance, and the slower dialysate flow rates may improve dissociation of copper off binding sites and across the membrane.…”

Section: Discussionmentioning

confidence: 99%

“…It is not removed by conventional dialytic therapies, which are poor in removing protein-bound substances. As albumin has specific binding sites for metals such as copper [8], albumin dialysis, which involves dialyzing blood against an albumin-containing dialysate across a semi-permeable membrane, may allow better clearance of both non-ceruloplasmin-bound and free copper and may play a role as a bridging therapy to liver transplantation in patients with fulminant WD.…”

Section: Introductionmentioning

confidence: 99%

Single Pass Albumin Dialysis and Plasma Exchange for Copper Toxicity in Acute Wilson Disease

Bakhsh

Teoh

Harvey

et al. 2019

Case Rep Nephrol Dial

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Background: Wilson disease (WD) is a disorder of copper metabolism that results in accumulation of copper in tissues. In acute WD, patients present with fulminant hepatic failure, encephalopathy, and hemolytic anemia due to copper release from necrotic hepatocytes. Many will require life-saving liver transplantation. Extracorporeal liver support systems can provide a bridge to transplantation for critically ill patients. We report our experience with 2 patients for whom we used a combination of plasma exchange (PLEX) and single pass albumin dialysis (SPAD), or SPAD alone as a bridge to liver transplantation. Case Reports: A 17-year-old girl (patient 1) and a 12-year-old boy (patient 2) presented with fulminant hepatic failure, hemolytic anemia, and acute kidney injury. Patient 1 received SPAD on days 2 and 3 (total 32 h). Serum copper decreased from 22.3 to 15.9 µmol/L (28.7% decrease), measured after 28 h of continuous SPAD. She underwent successful liver transplantation on day 4 after presentation. Patient 2 was treated with PLEX on days 1, 3, 4, and 5 and with SPAD on days 3–6. Serum copper decreased from 48.7 to 25.8 µmol/L (47% decrease) after the first session of PLEX and from 35.5 to 21.5 µmol/L (39.4% decrease) after the second session. The serum copper level was 16.2 µmol/L after 4 sessions of PLEX (and ongoing SPAD), with an overall 66.7% reduction in copper levels over 5 days combining both therapies. He underwent successful liver transplantation on day 6. Conclusion: We conclude that SPAD, with or without PLEX, is effective in reducing serum copper levels as a bridge to liver transplantation in WD. PLEX may be more efficient at removing copper but is associated with a rebound increase in copper levels between sessions.

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Albumin Regeneration in Liver Support—Comparison of Different Methods

Cited by 57 publications

References 43 publications

Single pass albumin dialysis (SPAD) in fulminant Wilsonian liver failure: a case report

Single pass albumin dialysis (SPAD) in fulminant Wilsonian liver failure: a case report

Longitudinal assessment of prognostic factors for patients with hepatorenal syndrome in a tertiary center

Single Pass Albumin Dialysis and Plasma Exchange for Copper Toxicity in Acute Wilson Disease

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