The molecular adsorbent recirculating system as a liver support system. Summary of Mexican experience

Cisneros-Garza, L.E.; Muñoz-Ramírez, Ma. del Rosario; Muñoz-Espinoza, Linda; Velasco, José Antonio Velarde Ruiz; Moreno-Alcántar, R.; Marín-López, E; Méndez-Sánchez, Nahúm

doi:10.1016/s1665-2681(19)30887-7

Cited by 22 publications

(17 citation statements)

References 30 publications

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“…However, MARS treatments can serve as a bridge for liver transplantation in severe poisoning in children [ 32 ]. In a recently published retrospective, multicenter study by Cisneros-Garza et al, after 79 MARS treatments in 38 patients, the authors found a significant reduction in bilirubin, transaminases, and bile acids, and a decrease in symptoms of hepatic encephalopathy, without a reduction of creatinine [ 33 ]. In contrast to our study, where all patients presented with AKI in the course of AoCLF or type 1 HRS, in the work by Cisneros-Garza et al only 5 patients (13%) had type 1 HRS.…”

Section: Discussionmentioning

confidence: 99%

Application of the Molecular Adsorbent Recirculating System in Type 1 Hepatorenal Syndrome in the Course of Alcohol-Related Acute on Chronic Liver Failure

et al. 2020

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Background This study aimed to evaluate the Molecular Adsorbent Recirculating System (MARS) effectiveness in patients with alcohol-related acute-on-chronic liver failure (AoCLF) complicated with type 1 hepatorenal syndrome (HRS). So far, MARS efficacy and safety has been demonstrated in various acute liver failure scenarios. Material/Methods Data from 41 MARS procedures (10 patients with type 1 HRS, in the course of alcohol-related AoCLF were considered for this study. Biochemical tests of blood serum were performed before and after each procedure. The condition of patients was determined before and after the treatment with the use of the model for end-stage liver disease – sodium (MELD-Na) and the stage of encephalopathy severity based on the West Haven criteria. Results During the observation period (20.5±13.9 days), 5 patients died, and the remaining 5 surviving patients were discharged from the hospital. In the group of 10, the 14-day survival, starting from the first MARS treatment, was 90%. The MARS procedure was associated with a 19% reduction in bilirubin (27.5±6.1 versus 22.3±4.0 mg/dL, P <0.001), 37% reduction in ammonia (44.1±22.5 versus 27.6±20.9 P <0.001), 27% reduction in creatinine (1.5±1.0 versus 1.1±0.6 mg/dL, P <0.001) and 14% reduction urea (83.8±36.1 versus 72.1±33.3, P <0.001) in blood serum samples, with stable hemodynamic parameters. In the group of patients discharged from the clinic (n=5), the MARS treatments resulted in an improvement in hepatic encephalopathy (West Haven; P =0.043), as well as a reduction in the MELD-Na score ( P =0.015). Conclusions MARS is a hemodynamically safe method for supporting the function of the liver and the kidneys. Application of the MARS reduces the symptoms of encephalopathy in patients with alcohol-related type 1 HRS.

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Section: Discussionmentioning

confidence: 99%

Application of the Molecular Adsorbent Recirculating System in Type 1 Hepatorenal Syndrome in the Course of Alcohol-Related Acute on Chronic Liver Failure

et al. 2020

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“…The elevated levels of circulating IL-6 and TNFα, also described by others[42,43], have been related to attempts at liver regeneration[44,45] and liver injury[46], respectively. Therapeutic approaches targeting the clearance of inflammatory/toxic products (plasmapheresis, hemodiafiltration, and bioartificial livers) from the liver or anti-cytokine therapy are currently being considered[42,47-49] despite contradictory clinical results[50,51]. …”

Section: Discussionmentioning

confidence: 99%

Changes in cellular proliferation and plasma products are associated with liver failure

Melgaço¹,

Soriani²,

Sucupira³

et al. 2016

WJH

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AIMTo study the differences in immune response and cytokine profile between acute liver failure and self-limited acute hepatitis.METHODSForty-six patients with self-limited acute hepatitis (AH), sixteen patients with acute liver failure (ALF), and twenty-two healthy subjects were involved in this study. The inflammatory and anti-inflammatory products in plasma samples were quantified using commercial enzyme-linked immunoassays and quantitative real-time PCR. The cellular immune responses were measured by proliferation assay using flow cytometry. The groups were divided into viral- and non-viral-induced self-limited AH and ALF. Thus, we worked with five groups: Hepatitis A virus (HAV)-induced self-limited acute hepatitis (HAV-AH), HAV-induced ALF (HAV-ALF), non-viral-induced self-limited acute hepatitis (non-viral AH), non-viral-induced acute liver failure (non-viral ALF), and healthy subjects (HC). Comparisons among HAV and non-viral-induced AH and ALF were performed.RESULTSThe levels of mitochondrial DNA (mtDNA) and the cytokines investigated [interleukin (IL)-6, IL-8, IL-10, interferon gamma, and tumor necrosis factor] were significantly increased in ALF patients, independently of etiology (P < 0.05). High plasma mtDNA and IL-10 were the best markers associated with ALF [mtDNA: OR = 320.5 (95%CI: 14.42-7123.33), P < 0.0001; and IL-10: OR = 18.8 (95%CI: 1.38-257.94), P = 0.028] and death [mtDNA: OR = 12.1 (95%CI: 2.57-57.07), P = 0.002; and IL-10: OR = 8.01 (95%CI: 1.26-50.97), P = 0.027]. In the cellular proliferation assay, NKbright, NKT and regulatory T cells (TReg) predominated in virus-specific stimulation in HAV-induced ALF patients with an anergic behavior in the cellular response to mitotic stimulation. Therefore, in non-viral-induced ALF, anergic behavior of activated T cells was not observed after mitotic stimulation, as expected and as described by the literature.CONCLUSIONmtDNA and IL-10 may be predictors of ALF and death. TReg cells are involved in immunological disturbance in HAV-induced ALF.

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“…In another single‐center observation from the Netherlands that included 20 children with ALF or graft dysfunction, MARS could be successfully applied but with similar coagulation side effects, and the need for liver transplantation was not reduced . Another single‐center experience from Mexico suggested that MARS reduced the need for liver transplantation by contributing to native liver recovery . However, a retrospective cohort study is not the optimal study design to answer this question.…”

Section: Currently Available Elsdsmentioning

confidence: 99%

“…(39) Another singlecenter experience from Mexico suggested that MARS reduced the need for liver transplantation by contributing to native liver recovery. (40) However, a retrospective cohort study is not the optimal study design to answer this question.…”

Section: Molecular Adsorbents Recirculating Systemmentioning

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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The molecular adsorbent recirculating system as a liver support system. Summary of Mexican experience

Cited by 22 publications

References 30 publications

Application of the Molecular Adsorbent Recirculating System in Type 1 Hepatorenal Syndrome in the Course of Alcohol-Related Acute on Chronic Liver Failure

Application of the Molecular Adsorbent Recirculating System in Type 1 Hepatorenal Syndrome in the Course of Alcohol-Related Acute on Chronic Liver Failure

Changes in cellular proliferation and plasma products are associated with liver failure

Extracorporeal liver support devices for listed patients

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