Liver Support by Extracorporeal Blood Purification: A Clinical Observation

Abstract

Liver failure associated with excretory insufficiency and jaundice results in an endogenous accumulation of toxins involved in the impairment of cardiovascular, kidney, and cerebral function. Moreover, these toxins have been shown to damage the liver itself by inducing hepatocellular apoptosis and necrosis, thus creating a vicious cycle of the disease. We report a retrospective cohort study of 26 patients with acute or chronic liver failure with intrahepatic cholestasis (bilirubin level > 20 mg/dL) who underwent a new extracorporeal blood purification treatment. A synthetic hydrophilic/hydrophobic domain-presenting semipermeable membrane (pore size < albumin size, 100-nm thick) was used for extracorporeal blood detoxification using dialysis equipment. The opposite side was rinsed with ligandin-like proteins as molecular adsorbents that were regenerated online using a chromatography-like recycling system (molecular adsorbent recirculating system [MARS]). Bile acid and bilirubin levels, representing the previously described toxins, were reduced by 16% to 53% and 10% to 90% of the initial concentration by a single treatment of 6 to 8 hours, respectively. Toxicity testing of patient plasma onto primary rat hepatocytes by live/dead fluorescence microscopy showed cell-damaging effects of jaundiced plasma that were not observed after treatment. Patients with a worsening of Child-TurcottePugh (CTP) index before the treatments showed a significant improvement of this index during a period of 2 to 14 single treatments with an average of 14 days. After withdrawal of MARS treatment, this improvement was sustained in all long-term survivors. Ten patients represented a clinical status equivalent to the United Network for Organ Sharing (UNOS) status 2b (group A1), and all survived. Sixteen patients represented a clinical status equivalent to UNOS status 2a, and 7 of these patients survived (group A2), whereas 9 patients (group B) died. We conclude that in acute excretory failure caused by a chronic liver disease, this treatment provides a therapy option to remove toxins involved in multiorgan dysfunction secondary to liver failure. (Liver Transpl 2000;6: 603-613.)

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

“…This effects the removal of such albuminbound toxins as aromatic amino acids, bilirubin, bile acids, phenols, short-and middle-chain fatty acids, and copper, together with such free solutes as ammonia, creatinine, and urea that are removed by standard dialysis. 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.…”

Detoxifying Capacity and Kinetics of the Molecular Adsorbent Recycling System

“…The clinical efficacy of the molecular adsorbent recycling system (MARS) has been demonstrated by several, although mainly uncontrolled observational trials [8,[10][11][12][13][14][15]. Clearances for albumin-bound liver failure toxins in the range of 10-60 ml/min have been reported [9].…”

Survival predictors in patients treated with a molecular adsorbent recirculating system

“…In 2001, when we began using MARS therapy, it was unclear which patients would benefit from the treatment. The only available data on MARS at the time were from a few small studies conducted on patients with AOCLF [19][20][21][22][23][24] . Therefore, data with the planned protocol were collected prospectively from every MARStreated patient in our ICU.…”