Should MARS and PROMETHEUS be Used in Patients with Liver Disease?

Gonwa, Thomas A.

doi:10.1111/sdi.12213

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…Although MARS therapy is well tolerated and reduces hepatic toxins, it remains unclear whether this "liver dialysis" improves the outcome, in the context of HRS [51].…”

Section: Post-operativementioning

confidence: 98%

Hepatic and renal effects of cardiopulmonary bypass

Tomasso

Monaco

Landoni

2015

Best Practice & Research Clinical Anaesthesiology

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“…Although MARS therapy is well tolerated and reduces hepatic toxins, it remains unclear whether this "liver dialysis" improves the outcome, in the context of HRS [51].…”

Section: Post-operativementioning

confidence: 98%

Hepatic and renal effects of cardiopulmonary bypass

Tomasso

Monaco

Landoni

2015

Best Practice & Research Clinical Anaesthesiology

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“… 138 RRT and ELS such as MARS or Prometheus may be of benefit in patients with HRS-AKI but should be restricted to patients who are candidates for liver transplantation. 139 , 140 Combined liver and kidney transplantation should be offered to patients on RRT for more than 12 weeks.…”

Section: Management Of Hrs-aki and Hrs Typementioning

confidence: 99%

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

et al. 2020

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Approximately one half of patients develop ascites within 10 years of diagnosis of compensated cirrhosis. It is a poor prognostic indicator, with only 50% surviving beyond two years. Mortality worsens significantly to 20% to 50% at one year if the ascites becomes refractory to medical therapy. Pakistan has one of the highest prevalence of viral hepatitis in the world and patients with ascites secondary to liver cirrhosis make a major percentage of both inpatient and outpatient burden. Studies indicate that over 80% of patients admitted with ascites have liver cirrhosis as the cause. This expert opinion suggests proper assessment of patients with ascites in the presence of underlying cirrhosis. This expert opinion includes appropriate diagnosis and management of uncomplicated ascites, refractory ascites and complicated ascites (including spontaneous bacterial peritonitis (SBP) ascites, hepatorenal syndrome (HRS) and hyponatremia. The purpose behind this expert opinion is to help consultants, postgraduate trainees, medical officers and primary care physicians optimally manage their patients with cirrhosis and ascites in a resource constrained setting as is often encountered in a developing country like Pakistan. doi: https://doi.org/10.12669/pjms.36.5.2407 How to cite this:Ali B, Salim A, Alam A, Zuberi BF, Ali Z, Azam Z, et al. HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2407 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…However, clinical data from controlled studies are scarce and results from large‐scale trials on MARS and Prometheus detoxification systems have shown that treatment with these devices may not confer a survival advantage . Yet, because of the positive effects on blood chemistry, hepatic encephalopathy, intractable pruritus, systemic circulatory dysfunction (MARS), and renal failure, liver dialysis techniques continue to be used in clinical practice .…”

mentioning

confidence: 99%

Albumin Apheresis for Artificial Liver Support: In Vitro Testing of a Novel Filter

et al. 2018

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Currently there is no direct therapy for liver failure. We have previously described selective plasma exchange therapy using a hemofilter permeable to substances that have a molecular mass of up to 100 kDa. The proof-of-concept studies and a Phase I study in patients with decompensated cirrhosis demonstrated that hemofiltration using an albumin-leaking membrane is safe and effective in removing target molecules, alleviating severe encephalopathy and improving blood chemistry. In this study a novel large-pore filter for similar clinical application is described. The performance of the filter was studied in vitro; it was found to effectively remove a wide spectrum of pathogenic factors implicated in the pathophysiology of hepatic failure, including protein bound toxins and defective forms of circulating albumin. Data on mass transport characteristics and functionality using various modes of filtration and dialysis provide rationale for clinical evaluation of the filter for artificial liver support using albumin apheresis.

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Should MARS and PROMETHEUS be Used in Patients with Liver Disease?

Cited by 7 publications

References 17 publications

Hepatic and renal effects of cardiopulmonary bypass

Hepatic and renal effects of cardiopulmonary bypass

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

Albumin Apheresis for Artificial Liver Support: In Vitro Testing of a Novel Filter

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