Assessment of resin perfusion in hepatic failurein vitroandin vivo

Abstract

AIM:To observe the adsorbent effect of resin on endotoxin, cytokine, bilirubin in plasma of patients with hepatic failure and to determine the resin perfusion as an artificial liver support system in the treatment of hepatic failure. METHODS:One thousand milliliters of discarded plasma was collected from each of 6 severe hepatitis patients treated with plasma exchange. The plasma was passed through a resin perfusion equipment for 1-2 h via extracorporeal circulation, and then absorbent indicators of transaminase, bilirubin, blood ammonia, endotoxin and cytokines were examined. In the meantime, study of in vivo resin plasma perfusion was performed on 7 severe hepatitis patients to compare the changes of endotoxin and cytokines in blood before and after perfusion. RESULTS:The levels of total bilirubin, endotoxin, interleukin 1β and TNF-α in plasma were significantly decreased after in vitro resin plasma perfusion. The levels of interleukin 1β, TNF-α and endotoxin in blood were also evidently declined after in vivo resin plasma perfusion. Nevertheless, no obvious changes in IL-6, creatinine (Cr) and urea nitrogen (UN), blood ammonia and electrolytes were found both in vitro and in vivo. CONCLUSION:Bilirubin, endotoxin and cytokines in plasma of patients with hepatic failure can be effectively adsorbed by resin in vitro. Most cytokines and endotoxin in plasma can also be effectively removed by resin in vivo. It demonstrates that resin perfusion may have good treatment efficacy on hepatic failure and can be expected to slow down the progression of hepatic failure.Wang YJ, Wang ZW, Luo BW, Liu HL, Wen HW. Assessment of resin perfusion in hepatic failure in vitro and in vivo. World J Gastroenterol 2004; 10(6): 837-840

Artificial Liver Support System in China: A Review Over the Last 30 Years

“…According to the VIP Database (an authoritative database of Chinese scientific journals), more than 800 papers or reviews on artificial liver have been published in China. Some results from China have also been reported in international journals (9–11).…”

“…The present review has summarized some technical aspects of ALSS, such as use of low molecular weight heparin, efficiency of various methods used singly or in combination, and prevention and treatment of complications (5,6,15,16). Evidence has shown ALSS can perform partial functions of liver, with important therapeutic effects in various patients with liver failure caused by severe hepatitis, pregnancy, or drugs, and in patients with severe end‐stage hepatitis awaiting LT (7,9–12,31,32,36–38).…”

New Type of Artificial Liver Support System (ALSS) Using the Photocatalytic Effect of Titanium Oxide

“…This result could be of considerable clinical importance, since cytokines are postulated to play a role in the process of liver regeneration [17], and cytokine removal may have a beneficial effect in clinical conditions such as systemic inflammatory response syndrome [18]. In the literature we searched for an ALSS that can remove various cytokines, the MARS [19,20] and the resin device [21] were identified (Table 1). Therefore, the utility of a blood module of TiO 2 was suggested by the experiment in this study, and future examination with other cytokines will be necessary.…”

Preparation and Adsorption Properties of Novel Porous Microspheres with Different Concentrations of Bilirubin

“…The complexity of this method for obtaining uniform PS of microspheres renders the high production cost of the materials. Porous polymer microspheres are functional polymer materials with a specific surface morphology; these microspheres have a large surface area (SA), strong adsorption capacity, controllable pore structure, and surface that can be modified depending on the requirements of applications [14,24] . In this paper, bilirubin-adsorbent microspheres, named as ERM-0100 and novel porous polymeric microspheres were synthesized using a pre-dispersion homogenizer through improved traditional suspension polymerization.…”

“…Commonly used adsorbents for plasma perfusion include activated carbon and coated activated carbon, synthetic polymer materials, natural modified polymer materials, and inorganic mesoporous materials [12][13][14][15][16][17][18][19][20][21][22][23] . Synthetic polymers are spherical adsorbents prepared by copolymerization [13] .…”