Efficacy of liver assisting in patients with hepatic encephalopathy with special focus on plasma exchange

Stenbøg, Poul; Busk, Troels M.; Larsen, Fin Stolze

doi:10.1007/s11011-013-9403-5

Cited by 29 publications

(14 citation statements)

References 16 publications

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“…PE was initially used for the treatment of liver diseases, providing valuable time for autogenic liver cell repair and for patients awaiting liver transplantation, especially for patients with acute liver failure (Stenbøg et al, 2013). In recent years, with increased understanding of disease pathogenesis and PE technology, PE indications have gradually expanded into neurology, hematology, critical care medicine, rheumatology, dermatology, and other fields (Erkurt et al, 2013;Kaya et al, 2013), but experience in pediatric applications is limited.…”

Section: Discussionmentioning

confidence: 99%

Plasma exchange parameter selection and safety observation of children with severe ricinism

Chen

Nie

et al. 2015

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to investigate the selection of plasma exchange (PE) parameters and the safety of children with severe ricinism. The PE parameters and heparin dosage in 7 children with severe ricinism were recorded, and changes in the patients' vital signs and coagulation function were monitored before and after PE. All patients successfully completed PE. The speed of blood flow was 50-80 mL/min, speed of exchange flow was 600-800 mL/h, and isolating rate of blood plasma was 12.5-19.05%. Transmembrane pressure was stable at approximately 100 mmHg, and venous pressure was stable at approximately 95 mmHg. The first dose of heparin was 0.39 ± 0.04 mg/ kg, and the maintaining heparin dose was 0.40 ± 0.05 to 0.22 ± 0.03 mg·kg -1 ·h -1 . During the PE process, mean arterial pressure, heart rate, respiratory rate, and pulse oxygen saturation were steady. After PE, the activated partial thromboplastin time and thrombin time prolonged to 4170 G.M. Chen et al. ©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (2): 4169-4176 (2015) 2-3 times greater than that before PE. However, no bleeding tendency was seen. For children with severe ricinism, the choice of PE to eliminate the toxin from blood, tissues, and organs was safe and effective.

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Section: Discussionmentioning

confidence: 99%

Plasma exchange parameter selection and safety observation of children with severe ricinism

Chen

Nie

et al. 2015

Genet. Mol. Res.

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“…A significant improvement in HE was also demonstrated with MARS in a recent metaanalysis [23]. Selective plasma exchange has showed beneficial effects in the management of acute hepatic encephalopathy in patients with liver failure [24]. In a recent study looking at the effect of plasma exchange on four patients with ALF, a significant decrease in hepatic encephalopathy and IL-18 levels was reported with plasma exchange [25].…”

Section: Hepatic Encephalopathy In Aclfmentioning

confidence: 92%

Liver dialysis in acute-on-chronic liver failure: current and future perspectives

et al. 2014

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Patients with acute-on-chronic liver failure (ACLF) are known to have a very high mortality rate as the majority of these patients succumb to multiorgan failure. Liver transplant remains the only option for these patients; however, there are problems with its availability, cost and also the complications and side effects associated with immunosuppression. Unlike advanced decompensated liver disease, there is a potential for hepatic regeneration and recovery in patients with ACLF. A liver support system, cell or non-cell based, logically is likely to provide temporary functional support until the donor liver becomes available or the failing liver survives the onslaught of the acute insult and spontaneously regenerates. Understanding the pathogenesis of liver failure and regeneration is essential to define the needs for a support system. Removal of hepatotoxic metabolites and inhibitors of hepatic regeneration by liver dialysis, a non-cell-based hepatic support, could help to provide a suitable microenvironment and support the failing liver. The current systems, i.e., MARS and Prometheus, have failed to show survival benefits in patients with ACLF based on which newer devices with improved functionality are currently under development. However, larger randomized trials are needed to prove whether these devices can enable restoration of the complex dysregulated immune system and impact organ failure and mortality in these patients.

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“…Its mechanism of action is supposed to include various immunomodulatory effects: removal of cytokines, antibodies, immune complexes and subsequent secondary modulation of immune cell proliferation and function [106]. In patients with ACLF, TPE was shown to reduce levels of various cytokines (TNF-α, IFN-γ, IL-10, IL-4, IL-2) [107] and ammonia levels [108,109]. In patients with HBV-induced ACLF, TPE allowed bridging to transplantation in situations where there was no immediate donor liver available [110].…”

Section: Other Therapeutic Interventions With Immunomodulatory Potencymentioning

confidence: 99%

Immunotherapy in the Treatment and Prevention of Infection in Acute-on-chronic Liver Failure

et al. 2015

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Chronic liver disease, depicted by gradual destruction and fibrosis of the liver, is a condition with high and probably increasing prevalence worldwide. Its deterioration, acute-on-chronic liver failure (ACLF), is characterized by an in-hospital mortality of up to 65%. Infectious complications are the main precipitants eliciting ACLF and concurrently the main cause of death from ACLF. Patients have a marked susceptibility to bacterial infections, which is thought to arise a consequence of an inadequate immune response to microbial challenge, termed immuneparesis. The pathophysiologic mechanisms remain poorly understood. Treatments aimed at restoring the patients' immune function may prevent onset of ACLF and death from secondary infections. A number of drugs approved for patients with liver disease bear immunomodulatory potential such as albumin, glucocorticoids, N-acetylcysteine. Specific targets have been defined that may lead to development of new immunotherapeutic agents. Here, we summarize the pathophysiology of immuneparesis in ACLF and drug candidates to restore immune function and improve survival in the future.

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Efficacy of liver assisting in patients with hepatic encephalopathy with special focus on plasma exchange

Cited by 29 publications

References 16 publications

Plasma exchange parameter selection and safety observation of children with severe ricinism

Plasma exchange parameter selection and safety observation of children with severe ricinism

Liver dialysis in acute-on-chronic liver failure: current and future perspectives

Immunotherapy in the Treatment and Prevention of Infection in Acute-on-chronic Liver Failure

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