Effect of MARS and PROMETHEUS on systemic hemodynamics and vasoactive agents in patients with acute on-chronic alcoholic liver failure: the clash of the titans

Laleman, Wim; Wilmer, A.; Evenepoel, Pieter; Verslype, Chris; Fevery, Johan; Nevens, Frederik

doi:10.1097/00042737-200601000-00133

Cited by 86 publications

(155 citation statements)

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“…Various randomized controlled trials in patients with ACLF have shown improvement in hepatic encephalopathy, hepatorenal syndrome, circulatory dysfunction, and immune dysfunction without improvement in transplant-free survival [123][124][125][126][127][128][129]. In the most recent meta-analysis and systematic review, no benefit of MARS treatment in reducing mortality as compared to SMT was noted [130], even though both these meta-analysis have the limitations of enrolling a heterogenous group of patients.…”

Section: Liver Transplantationmentioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, ''APASL ACLF Research Consortium (AARC),'' was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the

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Section: Liver Transplantationmentioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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“…In this context, some hope can be placed in non-biological extracorporeal liver support techniques in this group of patients. Extracorporeal liver support (ECLS) can be provided using the fractionated plasma separation and adsorption (FPSA) technique with the Prometheus system, the Molecular Adsorbent Recirculating System (MARS) or single pass albumin dialysis (SPAD) [4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…One of the main reasons for the scarcity of data seems to be the limited number of studied patients. Another notable fact is that there are no standards applicable to the use of these techniques [7,[11][12][13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

Piechota¹,

Piechota

Misztal

et al. 2019

aoms

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A b s t r a c t Introduction:The mortality rate in patients with severe liver dysfunction with no option of transplantation is unacceptably high. The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support (ECLS) techniques in this group of patients. Material and methods: Data from hospital admissions of 101 patients with severe liver dysfunction who were admitted to the department of anaesthesiology and intensive therapy between 2006 and 2015 were retrospectively analysed. The study group was divided into two subgroups. Standard medical therapy (SMT) was a subgroup of patients receiving standard medical therapy, and SMT + ECLS was a subgroup containing patients receiving standard medical therapy complemented by at least one extracorporeal liver support procedure. Extracorporeal liver support techniques used included fractionated plasma separation and adsorption and/or single pass albumin dialysis. Results: Significantly lower intensive care unit (ICU) mortality and 30-day mortality rates were found in the SMT + ECLS subgroup. No difference in 3-month mortality was identified between the two groups. In a multivariate model, independent risk factors for ICU mortality proved to be the SOFA score and prothrombin time. The highest discriminatory power for ICU mortality was demonstrated for the SOFA score, followed by APACHE II, SAPS II, MELD UNOS and GCS scores. For 30-day mortality, however, the best discriminatory power was shown for the SAPS II score, followed by SOFA, APACHE II, MELD UNOS and GCS scores. Conclusions: Further studies are needed to assess the contribution of non-biological extracorporeal liver support procedures to a decrease in mortality rates in the population of patients with severe liver dysfunction.

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“…amino acids [12], and ammonia [9], with conflicting results relating inflammation markers such as tumor necrosis factor-alpha [10,13,14], and interleukin-6 [10,14]. MARS was described in the improvement of hemodynamic parameters such as mean arterial pressure in 2 randomized, controlled studies, although no clinical outcome could be associated [7,15].…”

Section: Discussionmentioning

confidence: 99%

Liver Depurative Techniques: A Single Liver Transplantation Center Experience

Rodrigues

Castro

Moya

et al. 2015

Transplantation Proceedings

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Background. In a liver transplant (LT) center, treatments with Prometheus were evaluated. The main outcome considered was 1 and 6 months survival. Methods. During the study period, 74 patients underwent treatment with Prometheus; 64 were enrolled, with a mean age of 51 AE 13 years; 47 men underwent 212 treatments (mean, 3.02 per patient). The parameters evaluated were age, sex, laboratorial (liver enzymes, ammonia) and clinical (model for end-stage liver disease and Child-Turcotte-Pugh score) data. Results. Death was verified in 23 patients (35.9%) during the hospitalization period, 20 patients (31.3%) were submitted to liver transplantation, and 21 were discharged. LT was performed in 4 patients with acute liver failure (ALF, 23.7%), in 7 patients with acute on chronic liver failure (AoCLF, 43.7%), and in 6 patients with liver disease after LT (30%). Seven patients who underwent LT died (35%). In the multivariate analysis, older age (P ¼ .015), higher international normalized ratio (INR) (P ¼ .019), and acute liver failure (P ¼ .039) were independently associated with an adverse 1-month clinical outcome. On the other hand, older age (P ¼ .011) and acute kidney injury (P ¼ .031) at presentation were both related to worse 6-month outcome. For patients with ALF and AoCLF we did not observe the same differences. Conclusions. In this cohort, older age was the most important parameter defining 1-and 6-month survival, although higher INR and presence of ALF were important for 1-month survival and AKI for 6-month survival. No difference was observed between patients who underwent LT or did not have LT.

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Effect of MARS and PROMETHEUS on systemic hemodynamics and vasoactive agents in patients with acute on-chronic alcoholic liver failure: the clash of the titans

Cited by 86 publications

References 0 publications

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

Liver Depurative Techniques: A Single Liver Transplantation Center Experience

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