Cerebral blood flow velocity increases during a single treatment with the molecular adsorbents recirculating system in patients with acute on chronic liver failure

Schmidt, Lars E.; Svendsen, Lars Bo; Sørensen, Vibeke Rømming; Hansen, Bent Adel; Larsen, Fin Stolze

doi:10.1053/jlts.2001.26059

Cited by 89 publications

(55 citation statements)

References 16 publications

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“…The time spent in an improved mental state during the 5 days of the study was measured using the improvement proportion for each group (Table 3). These strict definitions of response contrast with earlier pilot studies by Stange et al, 8 Heemann et al, 19 and Novelli et al, 20 which did not define the extent of HE improvement or the time spent in the improved state. In this study, although not all patients had improvement in their HE, ECAD was more effective than the SMT group in resolving advanced stages of HE.…”

Section: Discussioncontrasting

confidence: 43%

“…Three patients in the ECAD group experienced gastrointestinal bleeding in the first week after therapy, an experience not seen in previous studies. 19,20 Limitations of the study should be noted. The control group did not receive the ideal comparison, standard albumin-free dialysis, because this approach could not be justified based on the lack of supportive data.…”

Section: Discussionmentioning

confidence: 99%

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Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis

et al. 2007

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Extracorporeal albumin dialysis (ECAD) may improve severe hepatic encephalopathy (HE) in patients with advanced cirrhosis via the removal of protein or non-protein-bound toxins. A prospective, randomized, controlled, multicenter trial of the efficacy, safety, and tolerability of ECAD using molecular adsorbent recirculating system (MARS) was conducted in such patients. Patients were randomized to ECAD and standard medical therapy (SMT) or SMT alone. ECAD was provided daily for 6 hours for 5 days or until the patient had a 2-grade improvement in HE. HE grades (West Haven criteria) were evaluated every 12 hours using a scoring algorithm. The primary endpoint was the difference in improvement proportion of HE between the 2 groups. A total of 70 subjects [median age, 53; 56% male; 56% HE grade 3; 44% HE grade 4; median model for end-stage liver disease (MELD) 32 (11-50) and CPT 13 (10-15)] were enrolled in 8 tertiary centers. Patients were randomized to ECAD ؉ SMT (n ‫؍‬ 39) or SMT alone (n ‫؍‬ 31). Groups were matched in demographics and clinical variables. The improvement proportion of HE was higher in ECAD (mean, 34%; median, 30%) versus the SMT group (mean, 18.9%; median, 0%) (P ‫؍‬ 0.044) and was reached faster and more frequently than in the SMT group (P ‫؍‬ 0.045). H epatic encephalopathy (HE) is a complex neuropsychiatric syndrome commonly seen in patients with advanced liver disease. HE arises from the effects of circulating toxins on cerebral functions. Putative toxic molecules accumulate in patients with liver decompensation because of increased production, portal-systemic shunting, or lack of hepatic detoxification. 1 Patients with advanced cirrhosis and a superimposed acute liver injury often decompensate and present with manifestations of hepatic failure, including worsening HE and coma. 2 .Current therapy for HE includes the use of nonabsorbable disaccharides or poorly absorbable antibiotics, as proposed more than 3 decades ago. 3 However, standard therapy is less effective in patients with severe degrees of liver failure. 4,5 Under these circumstances, the concept of supporting the failing liver for a time while correcting the precipitating event might help patients recover from HE or be stabilized until they receive a liver transplant. 6 Extracorporeal albumin dialysis (ECAD) using the molecular adsorbent recirculating system (MARS) is a new method of hemodiafiltration whereby blood is dialyzed against an albumin-containing solution across a high-flux membrane. 7 The technique allows combined removal of albumin-bound and water-soluble toxins. [8][9][10][11][12] In uncontrolled trials of ECAD using the MARS device, patients had a reduction in ammonia levels, clear-

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Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis

et al. 2007

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“…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. 14,15 Pruritus is more common in cholestatic liver diseases.…”

Section: A Molecular Adsorbent Recirculating System (Mars)mentioning

confidence: 99%

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

Doria

Mandalà

Smith

et al. 2003

Liver Transplantation

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“…The system thus detoxifies protein-bound toxins, whereas water-soluble substances follow mechanisms of diffusion and convection, as in conventional hemofiltration. 1,2 Schmidt et al 3 report the results of their study of 8 patients with acute on chronic liver failure and show that a single treatment with MARS is followed by a significant increase in cerebral blood flow (CBF) velocity, measured by transcranial Doppler of the middle cerebral artery. They also show a significant reduction in arterial ammonia concentrations, a reduction in serum bilirubin level, and an increase in mean arterial pressure.…”

mentioning

confidence: 99%

Editorial: Improvement in cerebral perfusion after MARS therapy: Further clues about the pathogenesis of hepatic encephalopathy?

Jalan

2001

Liver Transplantation

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Cerebral blood flow velocity increases during a single treatment with the molecular adsorbents recirculating system in patients with acute on chronic liver failure

Abstract: The aim of this uncontrolled pilot study is to determine the effect of treatment with the molecular adsorbents recirculating system (MARS) on cerebral perfusion in patients with acute on chronic liver failure (AOCLF). In 8 patients (

Cited by 89 publications

References 16 publications

Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis

Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis

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

Editorial: Improvement in cerebral perfusion after MARS therapy: Further clues about the pathogenesis of hepatic encephalopathy?

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