Hemodynamic changes during a single treatment with the molecular adsorbents recirculating system in patients with acute-on-chronic liver failure

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

doi:10.1053/jlts.2001.29108

Cited by 102 publications

(69 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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

View full text Add to dashboard Cite

“…5,6 Albumin dialysis devices, such as the molecular adsorbents recirculating system (MARS), have safely and efficiently removed albumin-bound, as well as water-soluble, substances without adverse effects on hemodynamics in patients with acute-on-chronic liver failure. [7][8][9] Assuming that systemic vasodilatation in patients with HALF is caused by circulating toxins removable by MARS, blood pressure and SVRI would be expected to increase during MARS treatment. 2,3 However, MARS is performed using a conventional dialysis machine at flow rates similar to those used for intermittent hemodialysis.…”

mentioning

confidence: 99%

Systemic hemodynamic effects of treatment with the molecular adsorbents recirculating system in patients with hyperacute liver failure: A prospective controlled trial

Schmidt

Wang

Hansen

et al. 2003

Liver Transplantation

Self Cite

208

106

View full text Add to dashboard Cite

The aim of the study is to evaluate the effect of a single treatment with the molecular adsorbents recirculating system (MARS) on systemic hemodynamics and oxygen consumption (VO 2 ) in patients with hyperacute liver failure (HALF). In a controlled design, eight patients with HALF were assigned to a 6-hour MARS treatment, and five patients, to a control group that was mechanically cooled to match the MARS group. Systemic hemodynamic variables were determined hourly during the study period. In the MARS group, systemic vascular resistance index increased by 46% from 1,215 ؎ 437 to 1,778 ؎ 710 dynes ⅐ s ⅐ cm ؊5 ⅐ m ؊2 (P < .0001), which significantly exceeded a 6% increase in the control group. Mean arterial pressure increased from 69 ؎ 5 to 83 ؎ 11 mm Hg in the MARS group (P < .0001) and was unchanged in the control group. Cardiac index decreased by 20% from 4.6 ؎ 1.8 to 3.7 ؎ 1.1 L/min ⅐ m ؊2 (P ‫؍‬ .0007) in the MARS group and by 7% in the control group. Heart rate decreased from 105 ؎ 21 to 85 ؎ 15 beats/min in the MARS group (P < .0001) and was unchanged in the control group. In the MARS group, oxygen delivery decreased from 621 ؎ 198 to 486 ؎ 141 mL/min ⅐ m ؊2 (P < .05), and VO2, from 142 ؎ 31 to 112 ؎21 mL/min ⅐ m ؊2 (P < .05). Arterial lactate and pH levels were unchanged. In conclusion, systemic hemodynamic values tend to normalize, whereas systemic VO 2 decreases during MARS treatment in patients with HALF. These effects cannot be explained by the degree of cooling associated with MARS. (Liver Transpl 2003;9: 290-297.)

show abstract

“…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- …”

mentioning

confidence: 99%

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

et al. 2007

View full text Add to dashboard Cite

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-

show abstract

Hemodynamic changes during a single treatment with the molecular adsorbents recirculating system in patients with acute-on-chronic liver failure

Cited by 102 publications

References 25 publications

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

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

Systemic hemodynamic effects of treatment with the molecular adsorbents recirculating system in patients with hyperacute liver failure: A prospective controlled trial

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

Contact Info

Product

Resources

About