Efficacy of Various Combined Blood Purification Techniques for Treating Patients with Non-viral Acute Liver Failure

Li, Maoqin; Li, Jia-qiong; Shi, Zai-xiang; Xu, Jingyi; Zhou, Zhenhai; Lu, Fei; Li, Lin; Xu, Yanjun; Xun, Mo; Lü, Bo; Wang, Xiaomeng; Ma, Lili; Zhang, Xianjiang; Cheng, Shu-Li

doi:10.1007/s12013-013-9740-3

Cited by 17 publications

(7 citation statements)

References 4 publications

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“…Unfortunately, this study also did not examine ammonia or creatinine levels. A total of 51 sessions were completed between 19 patients 55 . This study showed that when plasma exchange was combined with hemodiafiltration, it was more effective than when combined with hemoperfusion and all three treatments together were the most effective 55 …”

Section: Resultsmentioning

confidence: 88%

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Artificial liver support systems

Tandon

Froghi

2020

J of Gastro and Hepatol

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Artificial liver systems are used to bridge between transplantation or to allow a patient's liver to recover. They are used in patients with acute liver failure (ALF) and acute‐on‐chronic liver failure. There are five artificial systems currently in use: molecular adsorbent recirculating system (MARS), single‐pass albumin dialysis (SPAD), Prometheus, selective plasma filtration therapy, and hemodiafiltration. The aim is to compare existing data on the efficiency of these devices. A literature search was conducted using online libraries. Inclusion criteria included randomized control trials or comparative human studies published after the year 2000. A systematic review was conducted for the five individual devices with a more detailed comparison of the biochemistry for the SPAD and MARS systems. Eighty‐nine patients were involved in the review comparing SPAD and MARS. Results showed that there was an average reduction in bilirubin (−53 μmol/L in MARS and −50 μmol/L in SPAD), creatinine (−19.5 μmol/L in MARS and −7.5 μmol/L in SPAD), urea (−0.9 mmol/L in MARS and −0.75 mmol/L in SPAD), and gamma‐glutamyl transferase (−0.215 μmol/L·s in MARS and −0.295 μmol/L·s in SPAD) in both SPAD and MARS. However, there was no significant difference between the changes in the two systems. This review demonstrated that both MARS and SPAD aid recovery of ALF. There is no difference between the efficiency of MARS and SPAD. Because of the limited data, there is a need for more randomized control trials. Evaluating cost and patient preference would aid in differentiating the systems.

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Section: Resultsmentioning

confidence: 88%

“…The study showed that there was lower citrate and IL-18 levels but not IL-6 levels. 9 Li et al 55 examined 19 patients with multiple organ dysfunction syndrome and liver failure. This study also did not examine hemodiafiltration individually but compared it alongside plasma exchange and hemoperfusion.…”

Section: Resultsmentioning

confidence: 99%

Artificial liver support systems

Tandon

Froghi

2020

J of Gastro and Hepatol

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“…Additionally, the replacement fluid in TPE would contain albumin, which would further convert unconjugated bilirubin to conjugated bilirubin. Therefore, the innate process of TPE would effectively remove bilirubin as well as bind excess bilirubin through interaction with albumin resulting in effective management of hyperbilirubinemia which is well supported in the literature . Additionally, the combination of TPE with molecular adsorbent recirculating system (MARS) can more effectively reduce bilirubin levels.…”

Section: Discussionmentioning

confidence: 83%

Utilization of therapeutic plasma exchange for hyperbilirubinemia in a premature newborn on extracorporeal membrane oxygenation

Belousova

Tong

Bai

et al. 2019

J of Clinical Apheresis

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BACKGROUND:We report a case of a premature newborn girl with a hospital course complicated by suspected respiratory syncytial virus pneumonitis for which she was placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Despite phototherapy, her total bilirubin steadily increased to a peak of 50.4 mg/dL with concern for bilirubin-induced neurologic dysfunction, kernicterus. STUDY DESIGN AND METHODS: Therapeutic plasma exchange (TPE) was achieved via connection with the VA-ECMO circuit. Our institution's standard apheresis procedural parameters were adjusted to account for the small body weight and thus the low blood volume of the neonate while on ECMO. These included calculating the total blood volume to include the patient as well as the ECMO circuit, priming of the apheresis instrument with packed red blood cells to limit the extracorporeal volume, using a lower inlet flow rate, the connection setup of the inlet and return line, and monitoring of ionized calcium and anticoagulation throughout the procedure. RESULTS: A total of three TPE procedures were performed over three consecutive days. This resulted in improvement and stabilization of the patient's bilirubin. CONCLUSION: This case emphasizes that TPE is feasible on a neonate with a suboptimal body weight and thus a low blood volume due to the increased blood volume provided while on ECMO. In the absence of ECMO, whole blood manual exchange transfusion is recommended as TPE would be unsafe due to significant extracorporeal volume that would occur during TPE in a pediatric patient with low body weight.

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“…Moreover, the HA330 macroporous adsorption resin used in HP has a relative specificity for systemic inflammatory response syndrome, acute respiratory distress syndrome, sepsis and acute necrotic pancreatitis; thus, it can be used to remove the protein-bound toxins and toxic factors. PE is another blood purification modality that can remove antibodies, immune complexes, and toxins as well as replenish coagulation factors and other bioactive substances by using fresh frozen plasma [17,18] . However, PE alone cannot efficiently remove the medium and small toxin particles.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Two Combinations of Blood Purification Techniques for the Treatment of Multiple Organ Failure Induced by Wasp Stings

Yuan¹,

Chen²,

Hu³

et al. 2016

Blood Purif

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Background/Aims: The aim of this study was to explore the clinical efficacy of 2 combinations of blood purification techniques in patients with sting venom-induced multiple organ dysfunction syndrome (MODS). Methods: A total of 23 patients received 35 sessions of hemoperfusion (HP) + continuous veno-venous hemodiafiltration (CVVHDF) treatment and 22 sessions of plasma exchange (PE) + CVVHDF treatment, respectively. Results: Both HP + CVVHDF and PE + CVVHDF reduced the levels of inflammation, thus improving our patients' health condition. Moreover, PE + CVVHDF was found to be significantly more effective in reducing the levels of specific liver function markers and inflammatory mediators, as well as shortening prothrombin time and increasing the levels of serum albumin. Conclusion: Both combinations of blood purification techniques were capable of improving MODS. However, the PE + CVVHDF approach was more efficient for the removal of wasp venom and inflammatory mediators from the blood.

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Efficacy of Various Combined Blood Purification Techniques for Treating Patients with Non-viral Acute Liver Failure

Cited by 17 publications

References 4 publications

Artificial liver support systems

Artificial liver support systems

Utilization of therapeutic plasma exchange for hyperbilirubinemia in a premature newborn on extracorporeal membrane oxygenation

Efficacy of Two Combinations of Blood Purification Techniques for the Treatment of Multiple Organ Failure Induced by Wasp Stings

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