A non-bioartificial liver support system combined with transplantation in HBV-related acute-on-chronic liver failure

Abstract

We aim to determine the impact of an artificial liver support system (ALSS) treatment before liver transplantation (LT), and identify the prognostic factors and evaluate the predictive values of the current commonly used ACLF prognostic models for short-term prognosis after LT. Data from 166 patients who underwent LT with acute-on-chronic liver failure (ACLF) were retrospectively collected from January 2011 to December 2018 from the First Affiliated Hospital of Zhejiang University School of Medicine. Patients were divided into two groups depending on whether they received ALSS treatment pre-LT. In the observation group, liver function tests and prognostic scores were significantly lower after ALSS treatment, and the waiting time for a donor liver was significantly longer than that of the control group. Both intraoperative blood loss and period of postoperative ICU care were significantly lower; however, there were no significant differences between groups in terms of total postoperative hospital stays. Postoperative 4-week and 12-week survival rates in the observation group were significantly higher than those of the control group. Similar trends were also observed at 48 and 96 weeks, however, without significant difference. Multivariate Cox regression analysis of the risk factors related to prognosis showed that preoperative ALSS treatment, neutrophil–lymphocyte ratio, and intraoperative blood loss were independent predicting factors for 4-week survival rate after transplantation. ALSS treatment combined with LT in patients with HBV-related ACLF improved short-term survival. ALSS treatment pre-LT is an independent protective factor affecting the 4-week survival rate after LT.

A multi-subgroup predictive model based on clinical parameters and laboratory biomarkers to predict in-hospital outcomes of plasma exchange-centered artificial liver treatment in patients with hepatitis B virus-related acute-on-chronic liver failure

“…In the present study, NLR values after ALSS were inversely correlated with in-hospital outcomes. This conclusion agrees with other studies ( Fan et al., 2017 ; Li et al., 2021 ; Sheng et al., 2022 ). An NLR > 6.78 after ALSS treatment predicts high mortality risk.…”

A clinical study of non-bioartificial liver DPMAES support system in hepatitis B-related acute-on-chronic liver failure

“…A study conducted by Zhejiang University in China reviewed data from 166 patients with chronic liver failure and ACLF over the past 8 years, and the results showed that a non-biological artificial liver support system combined with transplantation significantly improved short-term survival rates. One partial mechanism is that artificial liver treatment reduces systemic inflammation and improves the internal environment 7 . While the combination of DPMAES with PE has shown promise, it often yields unsatisfactory results in patients with C-type ACLF, PT activity less than 20%, and TBiL levels exceeding 300 umol/L.…”

Combination of Plasma Exchange and Adsorption Versus Plasma Exchange in Pediatric Acute Liver Failure: A Multicenter Cohort Study

“…Bilirubin adheres to the resin in the BS330, whereas the resin in the HA330-II blood perfusion device adsorbs inflammatory mediators (16). There are several reports on the application of DPMAS in adult patients with ALF but few describing its use in pediatric patients with ALF (17)(18)(19)(20)(21)(22). Furthermore, the efficacy profiles of DPMAS combined with sequential half-dose PE and single fulldose PE have not been compared.…”