Amino acid dysbalance in liver failure is favourably influenced by recirculating albumin dialysis (MARS)

Peters, Eva M.J.; Stange, Jan; Loock, J.; Mitzner, S.; Schmidt, R.

doi:10.1034/j.1600-0676.2002.00006.x

Cited by 14 publications

(9 citation statements)

References 16 publications

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“…The fact that these patients were, therefore, in better clinical condition prior to LTX might contribute to the high overall survival of transplanted patients. The favorable effect of MARS treatment on laboratory parameters, as we observed, has also been reported in many small, uncontrolled studies [26,27,[37][38][39][40][41][42][43][44] . However, the improvement in laboratory values alone might be only temporary and does not necessarily predict a favorable outcome.…”

Section: Discussionsupporting

confidence: 65%

Survival predictors in patients treated with a molecular adsorbent recirculating system

Kantola¹,

Koivusalo²,

Parmanen³

et al. 2009

WJG

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AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system (MARS). METHODS:MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery, and as a bridge to liver transplantation (LTX). We analyzed the 1-year outcomes of 188 patients treated with MARS, from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic, clinical and laboratory parameters were recorded before and after each treatment. One-year survival and the number of LTXs were recorded. Logistic regression analysis was performed to determine factors predicting survival. RESULTS:The study included 113 patients with acute liver failure (ALF), 62 with acute-on-chronic liver failure (AOCLF), 11 with graft failure (GF), and six with miscellaneous liver failure. LTX was performed for 29% of patients with ALF, 18% with AOCLF and 55% with GF. The overall 1-year survival rate was 74% for ALF, 27% for AOCLF, and 73% for GF. The poorest survival rate, 6%, was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis, whereas, patients with enlarged and steatotic liver had 55% survival. The etiology of liver failure was the most important predictor of survival (P < 0.0001). Other prognostic factors were encephalopathy (P = 0.001) in paracetamol-related ALF, coagulation factors (P = 0.049) and encephalopathy (P = 0.064) in non-paracetamol-related toxic ALF, and alanine aminotransferase (P = 0.013) and factor V levels (P = 0.022) in ALF of unknown etiology. CONCLUSION:The etiology of liver disease was the most important prognostic factor. MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.

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Section: Discussionsupporting

confidence: 65%

Survival predictors in patients treated with a molecular adsorbent recirculating system

Kantola¹,

Koivusalo²,

Parmanen³

et al. 2009

WJG

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“…In contrast, Loock et al. reported a statistically significant decrease of BCAAs, interestingly without noticing a removal of them by both adsorbers used in MARS (6). Tryptophan is another important amino acid that is related to hepatic encephalopathy.…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

“…To date, two studies have reported data on the effect of MARS extracorporeal therapy on amino acids. Both articles described an improvement of the amino acid dysbalance(5,6). Schmidt et al found a reduction of total amino acid levels of around 20% under MARS in seven patients with acute liver failure as well as in five patients with acute-on-chronic liver failure(5).…”

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confidence: 99%

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Changes in Plasma Amino Acids During Extracorporeal Liver Support by Fractionated Plasma Separation and Adsorption

Rifai¹,

Rosenau²,

Ernst³

et al. 2010

Artificial Organs

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In patients with liver failure, amino acid dysbalance is common and associated with hepatic encephalopathy. Prometheus is a newly designed extracorporeal liver support system based upon fractionated plasma separation and adsorption (FPSA). We evaluated the influence of FPSA on plasma amino acid patterns in patients with liver failure and hepatic encephalopathy. We studied nine patients with acute-on-chronic liver failure, hepatic encephalopathy, and concomitant renal failure. A single session of FPSA therapy for 5 +/- 1 h was performed in all patients. Twenty-six different plasma amino acids were measured by high-performance liquid chromatography before and after FPSA treatment. Total amino acids as well as Fischer index were calculated. Additionally, a variety of clinical and biochemical parameters were assessed. Before FPSA was started, plasma levels of most amino acids were elevated. Plasma ammonia levels correlated with glutamine levels (P < 0.04). During FPSA, plasma levels of nearly all amino acids significantly decreased except for branched-chain amino acids. The Fischer index improved without reaching statistical significance. FPSA therapy tends to normalize plasma amino acids in patients with combined liver and renal failure. This may contribute to positive pathophysiologic effects, especially on hepatic encephalopathy. However, the clinical significance of these findings needs to be further evaluated.

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“…MARS was used continuously until LTx. Median time (range) on MARS treatment prior to LTx in groups I-III was 7 days (2-26), 6 days (1-17), and 5 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), and the median time on the waiting list was 5 days (1-11), 3 days (0-13), and 1 day (0-12), respectively. The HE grade prior to and after MARS was similar in all groups.…”

mentioning

confidence: 99%

Is It Possible to Gain Extra Waiting Time to Liver Transplantation in Acute Liver Failure Patients Using Albumin Dialysis?

Koivusalo¹,

Kantola²,

Arola

et al. 2009

Ther Apher Dial

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Hepatic encephalopathy (HE)-associated brain edema is a common cause of death in acute liver failure (ALF). Molecular Adsorbent Recirculating System (MARS) albumin dialysis detoxifies endogenous and exogenous toxins from blood and improves HE. In this study we assessed the effect of MARS on increasing the length of time available while waiting for liver graft. Thirty-seven patients with ALF who received a high-urgent liver transplant (LTx) were divided into three groups according to the amount of histological necrosis in the explanted liver: group I = 100% necrosis; group II = 80-99% necrosis; group III = less than 80% necrosis. MARS was used continuously until LTx. Median time (range) on MARS treatment prior to LTx in groups I-III was 7 days (2-26), 6 days (1-17), and 5 days (1-15), and the median time on the waiting list was 5 days (1-11), 3 days (0-13), and 1 day (0-12), respectively. The HE grade prior to and after MARS was similar in all groups. In two patients the HE grade decreased during MARS treatment, even though the explanted liver showed a complete lack of viable cells. Overall 30-day and one-year survival were 97% and 92%, respectively, without differences between the three groups. In ALF patients the liver cell damage progressed to total or near total necrosis of the liver when the waiting time was prolonged. Yet, with MARS treatment some patients with total hepatic necrosis showed an absence of encephalopathy. With MARS treatment some patients might be able to wait longer for a LTx with good results.

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Amino acid dysbalance in liver failure is favourably influenced by recirculating albumin dialysis (MARS)

Abstract: MARS enables an elevation of a pathologically decreased Fischer's Index as well as a reduction of systemic tryptophan levels in patients with liver failure. The effects of MARS on plasma amino acid dysbalance may contribute to an improvement of hepatic encephalopathy.

Cited by 14 publications

References 16 publications

Survival predictors in patients treated with a molecular adsorbent recirculating system

Survival predictors in patients treated with a molecular adsorbent recirculating system

Changes in Plasma Amino Acids During Extracorporeal Liver Support by Fractionated Plasma Separation and Adsorption

Is It Possible to Gain Extra Waiting Time to Liver Transplantation in Acute Liver Failure Patients Using Albumin Dialysis?

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