Prometheus® – a new extracorporeal system for the treatment of liver failure☆

Rifai, K.; Ernst, Thomas; Kretschmer, Ulrich; Bahr, Matthias J.; Schneider, Andrea; Hafer, Carsten; Haller, Hermann; Manns, Michael P.; Fliser, Danilo

doi:10.1016/s0168-8278(03)00468-9

Cited by 263 publications

(126 citation statements)

References 22 publications

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“…Rifai et al reported that both factor V and factor II remained stable during FPSA treatment in LF patients (13,14). In our patients, changes in the concentration of factor V (and factor VIII) were not observed equally.…”

Section: Discussioncontrasting

confidence: 44%

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Major Coagulation Disturbances During Fractionated Plasma Separation and Adsorption

Meijers¹,

Verhamme

Nevens³

et al. 2007

American Journal of Transplantation

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Fractionated Plasma Separation and Adsorption (FPSA) is a novel nonbiologic detoxification system for the removal of protein-bound solutes. FPSA is used to bridge patients during fulminant liver failure, either to functional recovery or to liver transplantation. Besides liver failure associated protein bound solutes, several important uremic retention solutes share important protein binding. We observed repeated occlusive thrombosis of the arterio-venous conduit during FPSA in hemodialysis (HD) patients, resulting in acute loss of function. A major reduction of several coagulation factors was demonstrated, exceeding 50% for factor II, factor X and protein C. Broad disturbances of the coagulation system were confirmed in FPSA treated liver failure patients. An ex vivo recirculation model demonstrated nonspecific adsorption of coagulation factors protein S and protein C on the anion exchange cartridge. Direct contact between fractionated plasma and the Prometh02 anion exchanger causes significant adsorption of procoagulant and anti-coagulant factors, associated with clinically relevant adverse events.

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Section: Discussioncontrasting

confidence: 44%

“…In contrast, we observed a major reduction of the factor II concentration. In the study by Rifai et al, only five out of nine patients were treated using the AE (13,14), which we have shown to be the cause of most losses.…”

Section: Discussionmentioning

confidence: 67%

Major Coagulation Disturbances During Fractionated Plasma Separation and Adsorption

Meijers¹,

Verhamme

Nevens³

et al. 2007

American Journal of Transplantation

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“…The first uncontrolled study conducted in 11 patients with acute-on-chronic liver failure (ACLF) and coexisting renal insufficiency showed FPSA to significantly reduce the level of conjugated bilirubin in the serum, and the levels of bile acids, ammonia, cholinesterase, creatinine and urea [23]. There were no significant changes in the level of haemoglobin and blood platelet count, while the leukocyte count was found to have increased [23].…”

Section: Discussionmentioning

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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“…The Prometheus ® (Fresenius Medical Care AG, Bad Homburg, Germany) system combines fractionated plasma separation and adsorption (FPSA [Fresenius Medical Care Allgemeine Gesellschaft, Bad Homburg, Germany]) with high-flux hemo dialysis for the removal of both albumin-bound and water-soluble toxins and was introduced by Falkenhagen in 1999 [89]. The device is schematically depicted in FigurE 6B.…”

Section: Prometheus ® or Fractionated Plasma Separation And Adsorptionmentioning

confidence: 99%

Acute-on-chronic liver failure: current concepts on definition, pathogenesis, clinical manifestations and potential therapeutic interventions

Laleman

Verbeke

Meersseman

et al. 2011

Expert Review of Gastroenterology & Hepatology

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Prometheus® – a new extracorporeal system for the treatment of liver failure☆

Cited by 263 publications

References 22 publications

Major Coagulation Disturbances During Fractionated Plasma Separation and Adsorption

Major Coagulation Disturbances During Fractionated Plasma Separation and Adsorption

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

Acute-on-chronic liver failure: current concepts on definition, pathogenesis, clinical manifestations and potential therapeutic interventions

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