Orthotopic Liver Transplantation for Fulminant Hepatic Failure

Nyckowski, P; Skwarek, Anna; Zieniewicz, Krzysztof; Patkowski, Waldemar; Alsharabi, A.; Wróblewski, Tadeusz; Remiszewski, Piotr; Smoter, Piotr; Kotulski, Marcin; Korba, Michał; Paczkowska, A; Giercuszkiewicz, Dorota; Sańko-Resmer, Joanna; Pączek, Leszek; Krawczyk, Marek

doi:10.1016/j.transproceed.2005.12.010

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…Non-conjugated bilirubin was eliminated only by FPSA. Nyckowski et al [19] used Prometheus during 'bridging therapy' with good results in 8 out of 31 patients with a UNOS-1 classification (extra-urgent indicated for LT). Other studies [20,21] also report improved biochemical results.…”

Section: Fpsa Support Therapy Of Alfmentioning

confidence: 99%

Fractionated Plasma Separation and Adsorption Significantly Decreases Intracranial Pressure in Acute Liver Failure: Experimental Study

Ryska¹,

Lasziková

Pantoflicek³

et al. 2009

Eur Surg Res

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Background: The aim of the study was to determine the influence of fractionated plasma separation and absorption (FPSA) on intracranial pressure (ICP) in acute liver failure (ALF). Methods: A surgical model of ALF in pigs (35–40 kg) was used. We compared laboratory data and haemodynamic parameters from the ALF control group to the ALF group treated by Prometheus using ANOVA with repeated measures and grouping factors, by calculating the area under the curve, and by the Mann-Whitney rank test. Results: Bilirubin levels differed significantly in favour of the FPSA treatment group: after 6 h 12.81 ± 6.54 versus 29.84 ± 9.99, after 9 h 11.94 ± 4.14 versus 29.95 ± 12.36 (p < 0.01) and after 12 h 13.88 ± 6.31 versus 26.10 ± 12.23 mmol/l (p < 0.05). ICP values differed significantly in favour of the FPSA treatment group: after 9 h 19.1 ± 4.09 versus 24.1 ± 2.85 (p < 0.01), after 10 h 21.9 ± 3.63 versus 25.1 ± 2.19, after 11 h 22.5 ± 3.98 versus 26.3 ± 3.50, and after 12 h 24.0 ± 4.66 versus 29.8 ± 5.88 mm Hg (p < 0.05). Conclusion: The authors demonstrated that a significant decrease in ICP was found in pigs with ALF following treatment by FPSA.

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Section: Fpsa Support Therapy Of Alfmentioning

confidence: 99%

Fractionated Plasma Separation and Adsorption Significantly Decreases Intracranial Pressure in Acute Liver Failure: Experimental Study

Ryska¹,

Lasziková

Pantoflicek³

et al. 2009

Eur Surg Res

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“…Initial and subsequent uncontrolled data for Prometheus show high elimination of albumin‐bound toxins and good safety data . Comparable to MARS, Prometheus can be used safely in patients awaiting an urgent liver transplantation, but severe coagulation disturbances have been reported . The largest cohort study of Prometheus in ALF patients was performed in Turkey and demonstrated safety and efficacy: one‐third of patients survived without transplantation, leading the authors to suggest that Prometheus may be effective as a bridge to recovery .…”

Section: Currently Available Elsdsmentioning

confidence: 99%

Extracorporeal liver support devices for listed patients

Lee¹,

Stadlbauer

Jalan

2016

Liver Transpl

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An alternative to liver transplantation for patients with liver failure remains an unmet need. In acute liver failure, the ideal extracorporeal liver support device (ELSD) would replace the functions of the failing liver in order to permit spontaneous recovery, given the incredible regenerative potential of the liver, negating the need for transplantation. In acute‐on‐chronic liver failure, an ELSD would ideally support hepatic function until a recovery to liver function before acute decompensation or until liver transplantation. In decompensated cirrhosis, an ELSD could again be used to support hepatic function until transplant. In addition, ELSDs may have the potential to treat the multiorgan failure that accompanies liver failure including hepatic encephalopathy, renal failure, and immune dysfunction or indeed potential to promote liver regeneration. Creation of an extracorporeal bioartificial liver able to completely replace liver function remains an unmet need. This review will describe a number of technologies suitable for clinical trials in humans, which have resulted from decades of engineering and biological research to develop a bioreactor able to adequately sustain functional hepatocytes. In addition, this review will describe artificial liver support devices that are primarily designed to replace the detoxifying functions of the liver and will consider the current data available or studies required to support their use in liver failure patients on the transplant waiting list. Liver Transplantation 22 839–848 2016 AASLD.

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“…[42]. The last trial included 31 patients who underwent OLT, with 61.8% survival at 3 months and 52.9% at 3 years [43]. Contraindications to OLT include multisystem organ failure, irreversible brain damage, uncontrolled sepsis, extrahepatic malignancy, and cerebral edema with sustained increase in the intracranial pressure above 50 mm Hg.…”

Section: Treatment Of Acetaminophen Overdosementioning

confidence: 99%

“…In the past 2 years, three published retrospective trials have shown similar overall survival[41][42][43]. The first trial included 40 patients and had a 1-year patient survival rate of 61.3%; OLT list time of less than 48 hours also improved outcomes[41].…”

mentioning

confidence: 99%

Epidemiology of acute liver failure

Khashab

Tector

Kwo

2007

Curr Gastroenterol Rep

128

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Acute liver failure (ALF) is an uncommon disorder that leads to jaundice, coagulopathy, and multisystem organ failure. Its definition is based on the timing from onset of jaundice to encephalopathy. In 2005, ALF accounted for 6% of liver-related deaths and 7% of orthotopic liver transplants (OLT) in the United States. Several classification systems have been developed for ALF, with the King's College criteria most widely used for prediction of OLT. Specific diagnostic tests should be implemented to identify the cause of ALF, which will help to determine its treatment and prognosis. Viral hepatitis was previously reported to be the most common cause of ALF in the United States, but acetaminophen overdose and idiosyncratic drug reactions have emerged as the most frequent causes in recent studies. Malignancy is an uncommon cause of ALF, and thus imaging studies may not be useful in this setting, but liver biopsy may be beneficial in selected cases. An overall strategy for ALF should start with identifying the cause, assessing the prognosis, and early transfer to a transplantation center for suitable candidates. OLT has emerged as a life-saving procedure leading to marked improvement in survival rates. Improved surgical techniques, immunosuppression, and comprehensive care have led to an overall survival rate of approximately 65% with OLT. N-acetylcysteine is effective in ALF caused by acetaminophen overdose, with results strongly related to how soon it is given rather than the route of administration. Liver support systems show potential for the treatment of ALF, but their role needs validation in large multicenter randomized trials.

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Orthotopic Liver Transplantation for Fulminant Hepatic Failure

Cited by 8 publications

References 6 publications

Fractionated Plasma Separation and Adsorption Significantly Decreases Intracranial Pressure in Acute Liver Failure: Experimental Study

Fractionated Plasma Separation and Adsorption Significantly Decreases Intracranial Pressure in Acute Liver Failure: Experimental Study

Extracorporeal liver support devices for listed patients

Epidemiology of acute liver failure

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