Application of Hemoadsorption in a Case of Liver Cirrhosis and Alcohol-Related Steatohepatitis with Preexisting Hepatitis C Infection

Büttner, Stefan; Patyna, Sammy; Koch, Benjamin; Finkelmeier, Fabian; Geiger, H; Sarrazin, Christoph; Farnik, Harald

doi:10.1159/000455064

Cited by 12 publications

(12 citation statements)

References 3 publications

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“…A new sorbent, Cytosorb ® , has demonstrated its ability to modulate inflammatory mediators in septic shock [12][13][14][15], as well as bilirubin and bile acids levels [12,13,[17][18][19]. A comparative study of various liver support techniques [18] showed an impressive bilirubin and bile acids MB with Cytosorb, compared to the other systems, thanks to continuous adsorption, up to 24 h, directly from the blood, whereas the other techniques work only for 4-6 h on plasma.…”

Section: Discussionmentioning

confidence: 99%

“…Experiment 3 was performed to study kinetics, trying to simulate in vivo therapeutic treatment, in a worst-case scenario, deduced from clinical experience with Cytosorb ® [12,13,17,18]. Finally, we performed a static laboratory test in a 100: 1 scaled down experimental setting, to verify the irreversibility of bilirubin-resin binding, pushing some beads charged with bilirubin into fresh albumin solution.…”

Section: In Vitro Protocolmentioning

confidence: 99%

“…Experimental and clinical studies have widely demonstrated their ability to modulate inflammatory mediators in septic shock [14][15][16]; preliminary case reports in systemic inflammatory response and septic shock [12,13], as well as recent experiences [17][18][19], have shown that the sorbent also reduces bilirubin and bile acids. This combined action may be helpful in supporting liver dysfunctions.…”

Section: Introductionmentioning

confidence: 99%

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Removal of Bilirubin with a New Adsorbent System: In Vitro Kinetics

Gemelli

Cuoghi

Magnani³

et al. 2018

Blood Purif

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Background/Aims: Many potentially toxic molecules accumulate in the blood during hepatic dysfunction. In clinical practice, it is very difficult to remove bilirubin, the most widely studied toxin, and particularly the unconjugated form, strongly albumin-bound. The aim of this in vitro study was to assess irreversible bilirubin adsorption as a protein-bound compound marker, using Cytosorb® (Cytosorbents Corp.), a new hemoadsorption device designed to remove cytokines. Methods: We performed 4 in vitro experiments, dynamic and static, with different albumin-bilirubin solutions. Results: All experiments showed the resin’s ability to break the albumin-bilirubin complex (Experiment 1, 2), leading to efficient bilirubin removal for 24 h (Removal Rate: 90% Experiment 3) with minimal albumin loss. No sign of bilirubin release from the charged resin was detected (Experiment 4). Conclusion: Cytosorb® seems a promising artificial liver support, thanks to its ability to adsorb bilirubin and its proven ability to modulate the cytokines involved in hepatic dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: In Vitro Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Removal of Bilirubin with a New Adsorbent System: In Vitro Kinetics

Gemelli

Cuoghi

Magnani³

et al. 2018

Blood Purif

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“…Evidence toward the direct and significant reduction in bilirubin plasma levels by the adsorber both in vitro and in patients has been shown elsewhere. 15,16 Recent data also show potential therapeutic effects of hemoadsorption on the reduction or even prevention of inflammation-induced lung injury by chemokine gradient control and leukocyte trafficking/infiltration toward infected tissues away from healthy organs 17 as well as improved fluid balance and even positive effects on vascular barrier function. 18 Another potential protective therapeutic approach of CytoSorb could be the reduction in increased levels of free hemoglobin generated by the Impella (low fluid load left, failing right ventricle) and hemodialysis, leading to acute kidney injury and an enhanced oxidative stress response.…”

Section: Discussionmentioning

confidence: 99%

Hemoadsorption in cardiac shock with bi ventricular failure and giant-cell myocarditis: A case report

et al. 2018

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Extracorporeal life support therapy represents a bridging approach to heart transplantation or to cardiac recovery and can be complemented by CytoSorb as an independent therapeutic option. The patient described herein with giant-cell myocarditis and fulminant cardiac failure who received substantial extracorporeal support in combination with CytoSorb hemoadsorption therapy benefited in terms of an improvement of organ function and his inflammatory situation.

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“…The Cytosorb was reported to be useful in patient with hyperbilirubinemia due to hepatic failure [33], in drug-induced cholestasis, alcoholic hepatitis [34], and cholestasis in sepsis [35]. It was used successfully in a liver cirrhosis patient with a pre-existing hepatitis C infection [36]. Additionally, in that paper, the authors reported a significant reduction in ammonia levels, which might be used in the treatment of severe hyperammonaemia in liver failure patients.…”

Section: State Of Knowledgementioning

confidence: 99%

Applications of Cytosorb in clinical practice

Kutnik¹,

Borys²

2019

J Pre Clin Clin Res.

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Introduction and objective. Cytososorb is haemadsorption device approved in the European Union in 2011 for cytokine adsorption. Recently, in 2018, new indications for the device use have been added, including bilirubin and myoglobin removal. This study aimed to present the results of studies pertaining to Cytosorb use in clinical practice. In subsequent sections of this review, indications for Cytosorb therapy and clinical relevance of presented evidence are listed. State of knowledge. In clinical practice, Cytosorb has been reported as one of potential supportive therapies in patients with septic shock. There is evidence of significant reduction of interleukin 6 and vasopressors when Cytosorb is implemented. However, the decreased mortality after Cytosorb has yet to be reported. Besides cytokine adsorption, Cytosorb also collects drugs, a property that can have a beneficial effect on acute drug poisoning (anticoagulants). However, Cytosorb lowers the plasma concentration of some antibiotics which might affect the outcome of patients in septic shock. The haemadsorption device has also been researched in cardiac patients, and some reports suggest a reduced need for vasopressors and blood transfusions when therapy is installed during surgery. Other indications for Cytosorb are also reported, especially the effectiveness in decreasing bilirubin serum concentrations as treatment or bridge therapy, without affecting the albumins. Cytosorb might also be the last resort treatment in acquired haemophagocytic lymphohistiocytosis. Conclusions. The evidence supporting the use of CytoSorb remains elusive. There is lack of large prospective studies which could provide definitive answers about the place of Cytosorb in clinical practice. There are no reports of safety and feasibility issues in all presented studies.

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Application of Hemoadsorption in a Case of Liver Cirrhosis and Alcohol-Related Steatohepatitis with Preexisting Hepatitis C Infection

Cited by 12 publications

References 3 publications

Removal of Bilirubin with a New Adsorbent System: In Vitro Kinetics

Removal of Bilirubin with a New Adsorbent System: In Vitro Kinetics

Hemoadsorption in cardiac shock with bi ventricular failure and giant-cell myocarditis: A case report

Applications of Cytosorb in clinical practice

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