Review article: liver support systems in acute hepatic failure

Rahman, TM; Hodgson, H. J. F.

doi:10.1046/j.1365-2036.1999.00597.x

Cited by 52 publications

(39 citation statements)

References 107 publications

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“…Removal could be accomplished through plasmapheresis, albumin infusions, or albumin dialysis using the molecular adsorbent recirculating system (MARS). 131,132 Perhaps the benefit of bile acid removal already has been shown because patients with type 1 HRS have shown improved survival on MARS treatment. 132 The MARS technique is discussed in greater detail in the sequel article.…”

Section: Other Mechanisms Of Renal Injury In the Setting Of Cirrhosismentioning

confidence: 99%

Pathophysiology of renal disease associated with liver disorders: Implications for liver transplantation. Part I

Davis

Gonwa

Wilkinson

2002

Liver Transplantation

117

131

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Section: Other Mechanisms Of Renal Injury In the Setting Of Cirrhosismentioning

confidence: 99%

Pathophysiology of renal disease associated with liver disorders: Implications for liver transplantation. Part I

Davis

Gonwa

Wilkinson

2002

Liver Transplantation

117

131

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“…1 Dialysis as a biocompatible method failed to remove the majority of toxins accumulating in liver failure because of their high protein-binding rate that prevented their passage through protein-impermeable dialysis membranes. More invasive detoxification methods, such as hemo-or plasmasorption, enabled greater clearance of protein-bound toxins because of direct contact between the sorbent and albumin-toxin complex and the large surface of these sorbents.…”

mentioning

confidence: 99%

“…2 However, negative side effects arising from plasma-sorbent contact representing an unsatisfying biocompatibility outweighed the basically positive effects of this treatment. 1,3 Another method is the removal of the patient's plasma by centrifugation or filter devices and replacement with fresh frozen plasma. 4 This method limits the amount of the removed toxins to that contained in the convection-filtered plasma in contrast to adsorption methods based on diffusive removal of toxins.…”

mentioning

confidence: 99%

Liver Support by Extracorporeal Blood Purification: A Clinical Observation

Stange

Mitzner

Klammt

et al. 2000

Liver Transplantation

132

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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.)

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“…Major side-effects are hypernatraemia, metabolic alkalosis and a decrease in colloid osmotic pressure. 16,17 There are no randomized trials on plasma exchange and case series reported no improvement in neurological function or mortality, despite improved coagulation parameters and decreased cytokine and endotoxin load. 86,87 High-volume plasmapheresis (HVP) is a more extreme method of plasma exchange and consists of exchanging more than 10 L of plasma.…”

Section: Plasmapheresis (Plasma Exchange)mentioning

confidence: 99%

“…[16][17][18][19] More specifically, biological devices include approaches with either whole organ perfusion using animal or human livers or with support systems that are based on a hepatocyte bioreactor. These techniques endeavour to replace the whole of hepatic functions.…”

Section: Which Types Of Liver Support Are Available?mentioning

confidence: 99%

Review article: non‐biological liver support in liver failure

Laleman¹,

Wilmer²,

Evenepoel³

et al. 2006

Aliment Pharmacol Ther

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SUMMARYLiver failure, whether acute or acute-on-chronic, remains an important cause of morbidity and mortality. The lack of liver detoxification, metabolic and regulatory functions of the liver leads to life-threatening complications, such as renal failure, altered immune response, hepatic coma and systemic haemodynamic dysfunction, eventually culminating in multiorgan failure.Current medical therapy involves the management of the precipitating event and treatment of complications until the liver eventually recovers, leaving us with no other treatment options than transplantation if these attempts fail. However, the shortage in cadaveric organs and other transplant-related problems, have prompted the need for alternative methods to provide liver support.As liver failure is often potentially reversible, considerable effort has been invested in the development of liver support systems. Currently, most of the experience is available for non-biological support systems. They represent the focus of this review, which aims to define the goals of liver support, to describe the design of the different existing devices and to analyse the available data to determine their current status in the management of patients with liver failure.

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Review article: liver support systems in acute hepatic failure

Cited by 52 publications

References 107 publications

Pathophysiology of renal disease associated with liver disorders: Implications for liver transplantation. Part I

Pathophysiology of renal disease associated with liver disorders: Implications for liver transplantation. Part I

Liver Support by Extracorporeal Blood Purification: A Clinical Observation

Review article: non‐biological liver support in liver failure

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