Effects of Fractionated Plasma Separation and Adsorption on Survival in Patients With Acute-on-Chronic Liver Failure

Kribben, Andreas; Gerken, Guido; Haag, Sebastian; Herget–Rosenthal, Stefan; Treichel, Ulrich; Betz, Christoph; Sarrazin, Christoph; Hoste, Eric; Vlierberghe, Hans Van; Escorsell, Àngels; Hafer, Carsten; Schreiner, Oliver; Galle, Peter R.; Mancini, Elena; Caraceni, Paolo; Karvellas, Constantine J.; Salmhofer, Hermann; Knotek, Mladen; Ginès, Pere; Kozik–Jaromin, Justyna; Rifai, K.

doi:10.1053/j.gastro.2011.12.056

Cited by 371 publications

(295 citation statements)

References 26 publications

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“…More recently, studies have shown that ALS could be an effective form of bridging therapy in patients with ACLF with high MELD scores awaiting liver transplantation and many believe it is a futile exercise in the absence of liver transplant [119,120]. These results have been substantiated by the recently published two large European randomized multicentric controlled trials, i.e., HELIOS (for Prometheus) [125] and RELIEF trial (for MARS) [124], that failed to show any benefit with these modalities on short-term transplant-free survival, which was the primary end point of these studies. The foremost reason for no demonstrable survival benefit with the currently available artificial liver support systems is the functional incompetence as most of these provide only the detoxification function of the entire armamentarium of liver functions and thus incorporation of synthetic function by living hepatocytes, i.e., the ''bioartificial liver'' or therapies to potentiate hepatic regeneration look more realistic.…”

Section: Liver Transplantationmentioning

confidence: 98%

“…Various randomized controlled trials in patients with ACLF have shown improvement in hepatic encephalopathy, hepatorenal syndrome, circulatory dysfunction, and immune dysfunction without improvement in transplant-free survival [123][124][125][126][127][128][129]. In the most recent meta-analysis and systematic review, no benefit of MARS treatment in reducing mortality as compared to SMT was noted [130], even though both these meta-analysis have the limitations of enrolling a heterogenous group of patients.…”

Section: Liver Transplantationmentioning

confidence: 99%

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Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, ''APASL ACLF Research Consortium (AARC),'' was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the

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Section: Liver Transplantationmentioning

confidence: 98%

Section: Liver Transplantationmentioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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“…[26,38] However, the albumin loss during Prometheus-therapy can reach 3 g/L (P = 0.055). [31,39] We observed no significant negative dynamics of serum albumin [oscillations: 32 (30-35) and 30 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35) g/L, P = 0.052, before and after MARS-therapy; 33 (31-34) and 31 (28-36) g/L, P = 0.051, before and after Prometheus-therapy], which is probably due to the adequate routine correction of hypoproteinemia in patients with ALF. [39] Likewise, despite published data on the loss of coagulation factors during Prometheus-therapy, [40] we did not observe clinically significant hemorrhagic complications.…”

Section: Extracorporeal Blood Purification In Intensive Care Patientsmentioning

confidence: 85%

“…[29] The beneficial effect of these procedures on clinical and laboratory parameters is explained by the removal of vasoactive substances and toxins, leading to improvements in organ and tissue perfusion, hemodynamic parameters and kidney function and reducing portal hypertension, intracranial pressure and hepatic encephalopathy. [30,31] The experience from implementing this therapy in adults allows the use of extracorporeal liver support to be recommended in pediatric practice. [32][33][34] MARS-therapy is a method of albumin dialysis that uses a filter permeable to substances with a molecular weight of up to 50 kDa.…”

Section: Extracorporeal Blood Purification In Intensive Care Patientsmentioning

confidence: 99%

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Yaroustovsky¹,

Abramyan²,

Komardina³

et al. 2017

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How to cite this article: Yaroustovsky M, Abramyan M, Komardina E, Nazarova H. Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery. Vessel Plus 2017;1:49-60.Extracorporeal blood purification is becoming increasingly important in intensive therapy for multiple organ dysfunction syndrome (MODS) and sepsis, considering all of their pathophysiological aspects. The results of treatment, particularly in children, considering their anatomical and physiological features, are related to the severity and progression of organ failure, the indications that are found, the choice of method, and the timely initiation of blood purification. Multiple organ support therapy is the aim of introducing and applying blood purification today. Various extracorporeal blood purification techniques directly affect the molecular and electrolyte composition of blood and influence all structures of the human body, which can allow us to correct, recover, replace and maintain homeostasis in MODS. The potential of new extracorporeal molecular technologies allows their successful use in severe cardiac and respiratory failure, acute kidney injury and hepatic dysfunction and in complex therapy for severe infections and sepsis and extreme metabolic violations. Adult and pediatric patients after cardiac surgery with cardiopulmonary bypass form a special cohort that often requires the application of various intra-and extracorporeal techniques due to the development of MODS, infections and sepsis in the postoperative period. Key words:Extracorporeal blood purification, acute kidney injury, acute liver failure, extracorporeal membrane oxygenation, sepsis, selective lipopolysaccharideadsorption, critical condition, cardiovascular surgery ABSTRACT Article history:

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“…Similarly, a prospective, randomized, controlled, parallelgroup multicenter trial reported no increase in the probability of survival of patients with AoCLF who were treated with the Prometheus system when compared with standard medical therapy (SMT); however, patients with a MELD score greater than 30 treated with Prometheus had a statistically significant better survival rate compared with that of patients treated with SMT only [17]. Another randomized, controlled trial with 102 patients with ALF found no statistical significance in the 6-month survival rate between SMT and MARS [18].…”

Section: Discussionmentioning

confidence: 99%

Liver Depurative Techniques: A Single Liver Transplantation Center Experience

Rodrigues

Castro

Moya

et al. 2015

Transplantation Proceedings

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Background. In a liver transplant (LT) center, treatments with Prometheus were evaluated. The main outcome considered was 1 and 6 months survival. Methods. During the study period, 74 patients underwent treatment with Prometheus; 64 were enrolled, with a mean age of 51 AE 13 years; 47 men underwent 212 treatments (mean, 3.02 per patient). The parameters evaluated were age, sex, laboratorial (liver enzymes, ammonia) and clinical (model for end-stage liver disease and Child-Turcotte-Pugh score) data. Results. Death was verified in 23 patients (35.9%) during the hospitalization period, 20 patients (31.3%) were submitted to liver transplantation, and 21 were discharged. LT was performed in 4 patients with acute liver failure (ALF, 23.7%), in 7 patients with acute on chronic liver failure (AoCLF, 43.7%), and in 6 patients with liver disease after LT (30%). Seven patients who underwent LT died (35%). In the multivariate analysis, older age (P ¼ .015), higher international normalized ratio (INR) (P ¼ .019), and acute liver failure (P ¼ .039) were independently associated with an adverse 1-month clinical outcome. On the other hand, older age (P ¼ .011) and acute kidney injury (P ¼ .031) at presentation were both related to worse 6-month outcome. For patients with ALF and AoCLF we did not observe the same differences. Conclusions. In this cohort, older age was the most important parameter defining 1-and 6-month survival, although higher INR and presence of ALF were important for 1-month survival and AKI for 6-month survival. No difference was observed between patients who underwent LT or did not have LT.

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Effects of Fractionated Plasma Separation and Adsorption on Survival in Patients With Acute-on-Chronic Liver Failure

Cited by 371 publications

References 26 publications

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Liver Depurative Techniques: A Single Liver Transplantation Center Experience

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