Artificial Liver Support with CytoSorb and MARS in Liver Failure: A Retrospective Propensity Matched Analysis

Popescu, Mihai; David, Corina; Marcu, Alexandra; Olita, Mihaela Roxana; Mihaila, Mariana; Tomescu, Dana

doi:10.3390/jcm12062258

Cited by 13 publications

(10 citation statements)

References 54 publications

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“…Similar to other authors [9,10,[17][18][19], we observed a reduction in serum bilirubin levels after CytoSorb ® treatment. However, in our case series, this reduction was transient.…”

Section: Discussionsupporting

confidence: 92%

Blood Purification in Hepatic Dysfunction after Liver Transplant or Extensive Hepatectomy: Far from the Best-Case Scenarios

Gaspari,

Aceto,

Spinazzola

et al. 2024

JCM

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Background: Hepatic dysfunction (HD) after liver transplantation (LT) or extended hepatic resection (EHR) is associated with graft failure and high short-term mortality. We evaluated the safety and depurative efficacy of CytoSorb® in these settings. The primary endpoint was the change in serum total bilirubin at the end of the treatment compared to the baseline value. The secondary endpoint was to evaluate the trend of serum total bilirubin and coagulation parameters up to 72 h after discontinuation of CytoSorb®. The effects of CytoSorb® therapy on the degree of hepatic encephalopathy (HE), Sequential Organ Failure Assessment (SOFA), and Model for End-Stage Liver Disease (MELD) scores as well as the hemodynamic status compared to baseline were also assessed. Methods: Adult patients with a serum total bilirubin level > 10 mg/dL admitted to the Intensive Care Unit were included. Exclusion criteria were hemodynamic instability, postoperative bleeding and platelet count < 20,000/mm3. Results: Seven patients were treated. Serum total bilirubin was significantly reduced at the end of treatment. However, seventy-two hours after the discontinuation of extracorporeal therapy, bilirubin levels returned to baseline levels in four patients. A decrease in platelet count was found during therapy, and platelet transfusion was required in six cases. A significant increase in D-dimer at the end of treatment was detected. HE degree, SOFA and MELD scores remained stable, while a deterioration in hemodynamic status was observed in two cases. Conclusions: Our preliminary findings did not show the possible benefits of CytoSorb® in rebalancing clinical and laboratory parameters in patients with HD after LT or EHR.

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“…Similar to other authors [9,10,[17][18][19], we observed a reduction in serum bilirubin levels after CytoSorb ® treatment. However, in our case series, this reduction was transient.…”

Section: Discussionsupporting

confidence: 92%

Blood Purification in Hepatic Dysfunction after Liver Transplant or Extensive Hepatectomy: Far from the Best-Case Scenarios

Gaspari,

Aceto,

Spinazzola

et al. 2024

JCM

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“…14 It has recently been shown that bilirubin can be removed directly by haemoadsorption treatment integrated into extracorporeal devices. [29][30][31][32] In line with these results, a degree of direct bilirubin removal by intraoperative haemoadsorption can be supposed. The preserved hepatic bilirubin excretion in Haemoadsorption in heart transplantation the interventional group correlated with less manifested post-operative organ dysfunction, associated with reduced VIS and mitigated PCT response as represented in our study group versus controls.…”

Section: Discussionmentioning

confidence: 86%

“…However, an arbitrary criterion was used to indicate intraoperative haemoadsorption in their investigation, definitely influencing patient selection bias in terms of pre‐operative immune priming level or risk and reversibility of post‐operative organ dysfunction 14 . It has recently been shown that bilirubin can be removed directly by haemoadsorption treatment integrated into extracorporeal devices 29–32 . In line with these results, a degree of direct bilirubin removal by intraoperative haemoadsorption can be supposed.…”

Section: Discussionmentioning

confidence: 99%

Use of intraoperative haemoadsorption in patients undergoing heart transplantation: a proof‐of‐concept randomized trial

Nemeth,

Soltesz,

Kovacs

et al. 2023

ESC Heart Failure

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AimsThe aim of this trial was to compare the clinical effects of intraoperative haemoadsorption versus standard care in patients undergoing orthotopic heart transplantation (OHT).Methods and resultsIn a randomized, controlled trial, OHT recipients were randomized to receive intraoperative haemoadsorption or standard care. Outcomes were vasoactive‐inotropic score (VIS), frequency of vasoplegic syndrome (VS) in the first 24 h; post‐operative change in procalcitonin (PCT) and C‐reactive protein (CRP) levels; intraoperative change in mycophenolic acid (MPA) concentration; frequency of post‐operative organ dysfunction, major complications, adverse immunological events and length of in‐hospital stay and 1‐year survival. Sixty patients were randomized (haemoadsorption group N = 30, control group N = 25 plus 5 exclusions). Patients in the haemoadsorption group had a lower median VIS and rate of VS (VIS: 27.2 [14.6–47.7] vs. 41.9 [22.4–63.2], P = 0.046, and VS: 20.0% vs. 48.0%, P = 0.028, respectively), a 6.4‐fold decrease in the odds of early VS (OR: 0.156, CI: 0.029–0.830, P = 0.029), lower PCT levels, shorter median mechanical ventilation (MV: 25 [19–68.8] hours vs. 65 [23–287] hours, P = 0.025, respectively) and intensive care unit stay (ICU stay: 8.5 [8.0–10.3] days vs. 12 [8.5–18.0] days, P = 0.022, respectively) than patients in the control group. Patients in the haemoadsorption versus control group experienced lower rates of acute kidney injury (AKI: 36.7% vs. 76.0%, P = 0.004, respectively), renal replacement therapy (RRT: 0% vs. 16.0%, P = 0.037, respectively) and lower median per cent change in bilirubin level (PCB: 2.5 [−24.6 to 71.1] % vs. 72.1 [11.2–191.4] %, P = 0.009, respectively) during the post‐operative period. MPA concentrations measured at pre‐defined time points were comparable in the haemoadsorption compared to control groups (MPA pre‐cardiopulmonary bypass: 2.4 [1.15–3.60] μg/mL vs. 1.6 [1.20–3.20] μg/mL, P = 0.780, and MPA 120 min after cardiopulmonary bypass start: 1.1 [0.58–2.32] μg/mL vs. 0.9 [0.45–2.10] μg/mL, P = 0.786). The rates of cardiac allograft rejection, 30‐day mortality and 1‐year survival were similar between the groups.ConclusionsIntraoperative haemoadsorption was associated with better haemodynamic stability, mitigated PCT response, lower rates of post‐operative AKI and RRT, more stable hepatic bilirubin excretion, and shorter durations of MV and ICU stay. Intraoperative haemoadsorption did not show any relevant adsorption effect on MPA. There was no increase in the frequency of early cardiac allograft rejection related to intraoperative haemoadsorption use.

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“…Lastly, the extracorporeal blood purification device CytoSorb-initially developed for removing inflammatory mediators and cytokines in septic shock-is now suggested as a new treatment strategy in patients with liver dysfunction, since it adsorbs hydrophobic molecules of up to 55 kilo Daltons (kDa) in size and can be combined with standard RRT techniques [26][27][28][29][30]. Though CytoSorb has been shown to sufficiently remove bilirubin and bile acids via hemadsorption, the current data are limited to retrospective data, case series and in vitro data, and the expansion of its use to patients with ALF or ALD remains controversial [19,28,29,[31][32][33].…”

Section: Introductionmentioning

confidence: 99%

Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety

Göth

Mähler

Kälble

et al. 2023

JCM

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Extracorporeal liver-support therapies remain controversial in critically ill patients, as most studies have failed to show an improvement in outcomes. However, heterogeneous timing and inclusion criteria, an insufficient number of treatments, and the lack of a situation-dependent selection of available liver-support modalities may have contributed to negative study results. We retrospectively investigated the procedural characteristics and safety of the three liver-support therapies CytoSorb, Molecular Adsorbent Recirculating System (MARS) and therapeutic plasma exchange (TPE). Whereas TPE had its strengths in a shorter treatment duration, in clearing larger molecules, affecting platelet numbers less, and improving systemic coagulation and hemodynamics, CytoSorb and MARS were associated with a superior reduction in particularly small protein-bound and water-soluble substances. The clearance magnitude was concentration-dependent for all three therapies, but additionally related to the molecular weight for CytoSorb and MARS therapy. Severe complications did not appear. In conclusion, a better characterization of disease-driving as well as beneficial molecules in critically ill patients with acute liver dysfunction is crucial to improve the use of liver-support therapy in critically ill patients. TPE may be beneficial in patients at high risk for bleeding complications and impaired liver synthesis and hemodynamics, while CytoSorb and MARS may be considered for patients in whom the elimination of smaller toxic compounds is a primary objective.

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Artificial Liver Support with CytoSorb and MARS in Liver Failure: A Retrospective Propensity Matched Analysis

Cited by 13 publications

References 54 publications

Blood Purification in Hepatic Dysfunction after Liver Transplant or Extensive Hepatectomy: Far from the Best-Case Scenarios

Blood Purification in Hepatic Dysfunction after Liver Transplant or Extensive Hepatectomy: Far from the Best-Case Scenarios

Use of intraoperative haemoadsorption in patients undergoing heart transplantation: a proof‐of‐concept randomized trial

Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety

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