Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis

Jalan, Rajiv; Sen, Sambit; Steiner, Christian; Kapoor, Dharmesh; Alisa, A; Williams, Roger

doi:10.1016/s0168-8278(02)00334-3

Cited by 171 publications

(93 citation statements)

References 35 publications

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“…The fact that these patients were, therefore, in better clinical condition prior to LTX might contribute to the high overall survival of transplanted patients. The favorable effect of MARS treatment on laboratory parameters, as we observed, has also been reported in many small, uncontrolled studies [26,27,[37][38][39][40][41][42][43][44] . However, the improvement in laboratory values alone might be only temporary and does not necessarily predict a favorable outcome.…”

Section: Discussionsupporting

confidence: 87%

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Survival predictors in patients treated with a molecular adsorbent recirculating system

Kantola¹,

Koivusalo²,

Parmanen³

et al. 2009

WJG

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AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system (MARS). METHODS:MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery, and as a bridge to liver transplantation (LTX). We analyzed the 1-year outcomes of 188 patients treated with MARS, from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic, clinical and laboratory parameters were recorded before and after each treatment. One-year survival and the number of LTXs were recorded. Logistic regression analysis was performed to determine factors predicting survival. RESULTS:The study included 113 patients with acute liver failure (ALF), 62 with acute-on-chronic liver failure (AOCLF), 11 with graft failure (GF), and six with miscellaneous liver failure. LTX was performed for 29% of patients with ALF, 18% with AOCLF and 55% with GF. The overall 1-year survival rate was 74% for ALF, 27% for AOCLF, and 73% for GF. The poorest survival rate, 6%, was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis, whereas, patients with enlarged and steatotic liver had 55% survival. The etiology of liver failure was the most important predictor of survival (P < 0.0001). Other prognostic factors were encephalopathy (P = 0.001) in paracetamol-related ALF, coagulation factors (P = 0.049) and encephalopathy (P = 0.064) in non-paracetamol-related toxic ALF, and alanine aminotransferase (P = 0.013) and factor V levels (P = 0.022) in ALF of unknown etiology. CONCLUSION:The etiology of liver disease was the most important prognostic factor. MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.

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Section: Discussionsupporting

confidence: 87%

“…In AOCLF, some randomized studies [5,6,8,22] and small case series of MARS-treated patients [25][26][27] have reported favorable effects. However, conflicting reports have also emerged [28] .…”

Section: Discussionmentioning

confidence: 99%

Survival predictors in patients treated with a molecular adsorbent recirculating system

Kantola¹,

Koivusalo²,

Parmanen³

et al. 2009

WJG

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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%

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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“…Indeed, extra-corporal liver support has turned out to be a valuable supplement to standard medical therapy (SMT) [1] . Especially, albumin dialysis improves not only the general condition, but also both cardiovascular and renal function [2][3][4][5][6][7] as well as the degree of hepatic encephalopathy [1,8,9] . The Fractionated Plasma Separation, Adsorption and Dialysis (Prometheus™) system and the Molecular Adsorbent Recirculation System (MARS™) both represent such treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

Effect of Prometheus liver assist system on systemic hemodynamics in patients with cirrhosis: A randomized controlled study

Dethloff¹,

Tofteng²,

Frederiksen³

et al. 2008

WJG

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Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis

Cited by 171 publications

References 35 publications

Survival predictors in patients treated with a molecular adsorbent recirculating system

Survival predictors in patients treated with a molecular adsorbent recirculating system

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

Effect of Prometheus liver assist system on systemic hemodynamics in patients with cirrhosis: A randomized controlled study

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