Extracorporeal liver support in patients with liver failure: a systematic review and meta-analysis of randomized trials

Alshamsi, Fayez; Alshammari, Khalil; Belley‐Côté, Emilie P.; Dionne, Joanna C.; Albrahim, Talal; Albudoor, Budoor; Ismail, Mona H; Al-Judaıbı, Bandar; Baw, Bandar; Subramanian, Ram; Steadman, Randolph H.; Galusca, Dragos; Huang, David T.; Nanchal, Rahul; Quraini, M. Al; Yuan, Yuhong; Alhazzani, Waleed

doi:10.1007/s00134-019-05783-y

Cited by 70 publications

(80 citation statements)

References 56 publications

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“…Over the past three decades, artificial liver support system (ALSS) therapy has been developed to be an therapeutic option as removal of toxins improves the capacity of the liver to regenerate. Some studies found that ALSS therapy could improve the short-term prognosis of patients with ACLF 6 – 9 , especially under the mode of plasma exchange (PE) 7 , 8 . Thus, PE has been one of the recommended therapeutic methods for patients with liver failure in China and USA 10 – 12 .…”

Section: Introductionmentioning

confidence: 99%

A prognostic score for patients with acute-on-chronic liver failure treated with plasma exchange-centered artificial liver support system

Zhou

et al. 2021

Sci Rep

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Artificial liver support system (ALSS) therapy is widely used in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). We aimed to develop a predictive score to identify the subgroups who may benefit from plasma exchange (PE)-centered ALSS therapy. A total of 601 patients were retrospectively enrolled and randomly divided into a derivation cohort of 303 patients and a validation cohort of 298 patients for logistic regression analysis, respectively. Five baseline variables, including liver cirrhosis, total bilirubin, international normalized ratio of prothrombin time, infection and hepatic encephalopathy, were found independently associated with 3-month mortality. A predictive PALS model and the simplified PALS score were developed. The predicative value of PALS score (AUROC = 0.818) to 3-month prognosis was as capable as PALS model (AUROC = 0.839), R score (AUROC = 0.824) and Yue-Meng’ score (AUROC = 0.810) (all p > 0.05), and superior to CART model (AUROC = 0.760) and MELD score (AUROC = 0.765) (all p < 0.05). The PALS score had significant linear correlation with 3-month mortality (R2 = 0.970, p = 0.000). PALS score of 0–2 had both sensitivity and negative predictive value of > 90% for 3-month mortality, while PALS score of 6–9 had both specificity and positive predictive value of > 90%. Patients with PALS score of 3–5 who received 3–5 sessions of ALSS therapy had much lower 3-month mortality than those who received 1–2 sessions (32.8% vs. 59.2%, p < 0.05). The more severe patients with PALS score of 6–9 could still benefit from ≥ 6 sessions of ALSS therapy compared to ≤ 2 sessions (63.6% vs. 97.0%, p < 0.05). The PALS score could predict prognosis reliably and conveniently. It could identify the subgroups who could benefit from PE-centered ALSS therapy, and suggest the reasonable sessions.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000032055. Registered 19th April 2020, http://www.chictr.org.cn/showproj.aspx?proj=52471.

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Section: Introductionmentioning

confidence: 99%

A prognostic score for patients with acute-on-chronic liver failure treated with plasma exchange-centered artificial liver support system

Zhou

et al. 2021

Sci Rep

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“…In a metaanalysis published in 2019 [7], there was no difference in the survival of patients receiving standard medical support or MARS, but patients receiving high-intensity therapy with five or more MARS sessions showed better survival than those receiving low-intensity therapy with four or fewer sessions. Furthermore, a meta-analysis published in 2020 [15] Bleeding complications can also promote disseminated intravascular coagulation in patients with liver failure, making medical staff hesitant to proceed with liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

Bleeding Complications Associated With the Molecular Adsorbent Recirculating System: A Retrospective Observational Study

Yoo¹,

Dk²,

Ki³

et al. 2020

Preprint

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Background: The molecular adsorbent recirculating system (MARS) is an artificial liver support system that supports excretory liver function in patients with liver failure and is used as bridge therapy for patients waiting for liver transplantation. However, MARS may increase the tendency for bleeding. The objective of this study was to determine how MARS affects coagulopathy and identify specific factors associated with bleeding complications. Methods: We retrospectively analyzed data from 15 patients undergoing a total of 36 MARS sessions. Complete blood count, coagulation profiles, and blood chemistry values were compared before and after MARS. To identify pre-MARS factors associated with increased bleeding after MARS, we divided patients into bleeder and non-bleeder groups and compared their pre-MARS laboratory values. Results: MARS significantly reduced bilirubin and creatinine levels. MARS also increased prothrombin time and activated partial thromboplastin time and reduced fibrinogen, thus negatively impacting coagulation. Seven patients had bleeding complications and were classified into the bleeder group. Pre MARS hemoglobin was significantly lower in the bleeder group (8.3 mg/dl) than in the non bleeder group (10.0 mg/dl, P=0.014). When comparing the upper and lower 25 % of MARS sessions based on the hemoglobin reduction rate, hemoglobin reduction was significantly greater in MARS sessions involving patients with low pre MARS hemoglobin and factor V (P=0.008 and P=0.032, respectively). Conclusions: MARS appears to alter coagulation related factors and increase the risk of bleeding complications. However, individual differences among patients were large, and various factors, such as low hemoglobin and factor V levels, appear to be involved.

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“…Liver transplantation (LT) is an effective therapy to reduce mortality and increase survival rate (Finkenstedt et al, 2013;Chan and Fan, 2015;Artru et al, 2017). However, the lack of donor organs and high medical cost are major barriers for LT. Non-biological artificial liver support (ALS) devices remove circulating toxins using dialysis-based techniques (Chen et al, 2016;Alshamsi et al, 2020). However, ALS-like MARS provide no significant survival benefit (Banares et al, 2013).…”

Section: Classical Therapy Strategiesmentioning

confidence: 99%

Acute-on-Chronic Liver Failure From Chronic-Hepatitis-B, Who Is the Behind Scenes

Wang

et al. 2020

Front. Microbiol.

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Acute-on-chronic liver failure (ACLF) is an acute syndrome accompanied with decompensation of cirrhosis, organ failure with high 28-day mortality rate. Systemic inflammation is the main feature of ACLF, and poor outcome is closely related with exacerbated systemic inflammatory responses. It is well known that severe systemic inflammation is an important event in chronic hepatitis B (CHB)-ACLF, which eventually leads to liver injury. However, the initial CHB-ACLF events are unclear; moreover, the effect of these events on host immunity as well as that of immune imbalance on CHB-ACLF progression are unknown. Here, we investigate the initial events of ACLF progression, discuss possible mechanisms underlying ACLF progression, and provide a new model for ACLF prediction and treatment. We review the characteristics of ACLF, and consider its plausible immune predictors and alternative treatment strategies.

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Extracorporeal liver support in patients with liver failure: a systematic review and meta-analysis of randomized trials

Cited by 70 publications

References 56 publications

A prognostic score for patients with acute-on-chronic liver failure treated with plasma exchange-centered artificial liver support system

A prognostic score for patients with acute-on-chronic liver failure treated with plasma exchange-centered artificial liver support system

Bleeding Complications Associated With the Molecular Adsorbent Recirculating System: A Retrospective Observational Study

Acute-on-Chronic Liver Failure From Chronic-Hepatitis-B, Who Is the Behind Scenes

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