Fractionated Plasma Separation and Adsorption System: A Novel System for Blood Purification to Remove Albumin Bound Substances

Falkenhagen, D; Strobl, W.; Vogt, G.; Schrefl, A.; Linsberger, Ingrid; Gerner, F.J.; Schoenhofen, Michael

doi:10.1046/j.1525-1594.1999.06292.x

Cited by 217 publications

(130 citation statements)

References 23 publications

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“…The separated plasma then passes through a neutral resin absorbent column (Prometh01, Fresenius AG, Bad Homburg, Germany) and an anion exchange resin absorber (Prometh02, Fresenius AG, Bad Homburg, Germany) to remove albumin-bound toxins. The plasma phase is then returned to the filter and dialyzed as whole blood in a high flow dialyzer (F60S, Fresenius) to remove water-soluble toxins [22]. After a preliminary phase involving a gradual increase in the blood and plasma flow rates in the secondary circuit, which required approximately 12 min, the treatment was performed with a blood flow of 180 ml/ min and a plasma flow of 270-360 ml/min.…”

Section: Fpsa Treatmentmentioning

confidence: 99%

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

Piechota¹,

Piechota

Misztal

et al. 2019

aoms

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A b s t r a c t Introduction:The mortality rate in patients with severe liver dysfunction with no option of transplantation is unacceptably high. The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support (ECLS) techniques in this group of patients. Material and methods: Data from hospital admissions of 101 patients with severe liver dysfunction who were admitted to the department of anaesthesiology and intensive therapy between 2006 and 2015 were retrospectively analysed. The study group was divided into two subgroups. Standard medical therapy (SMT) was a subgroup of patients receiving standard medical therapy, and SMT + ECLS was a subgroup containing patients receiving standard medical therapy complemented by at least one extracorporeal liver support procedure. Extracorporeal liver support techniques used included fractionated plasma separation and adsorption and/or single pass albumin dialysis. Results: Significantly lower intensive care unit (ICU) mortality and 30-day mortality rates were found in the SMT + ECLS subgroup. No difference in 3-month mortality was identified between the two groups. In a multivariate model, independent risk factors for ICU mortality proved to be the SOFA score and prothrombin time. The highest discriminatory power for ICU mortality was demonstrated for the SOFA score, followed by APACHE II, SAPS II, MELD UNOS and GCS scores. For 30-day mortality, however, the best discriminatory power was shown for the SAPS II score, followed by SOFA, APACHE II, MELD UNOS and GCS scores. Conclusions: Further studies are needed to assess the contribution of non-biological extracorporeal liver support procedures to a decrease in mortality rates in the population of patients with severe liver dysfunction.

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Section: Fpsa Treatmentmentioning

confidence: 99%

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

Piechota¹,

Piechota

Misztal

et al. 2019

aoms

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“…Another system, called fractionated plasma separation and adsorption (PFSA), which also removes albuminbound substances has been developed. 3 Results from clinical trials with this treatment are awaited.…”

Section: Commentsmentioning

confidence: 99%

Treatment of hepatorenal syndrome: Lessons from the MARS trial

Mullen

2002

Hepatology

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In hepatorenal syndrome (HRS), renal insufficiency is often progressive, and the prognosis is extremely poor under standard medical therapy. The molecular adsorbent recirculating system (MARS) is a modified dialysis method using an albumin-containing dialysate that is recirculated and perfused online through charcoal and anion-exchanger columns. MARS enables the selective removal of albumin-bound substances. A prospective controlled trial was performed to determine the effect of MARS treatment on 30-day survival in patients with type I HRS at high risk (bilirubin level, >15 mg/dL) compared with standard treatment. Thirteen patients with cirrhosis with type I HRS were included from 1997 to 1999. All were Child's class C, with Child-Turcotte-Pugh scores of 12.4 ؎ 1.0, United Network for Organ Sharing status 2A, and total bilirubin values of 25.7 ؎ 14.0 mg/dL. Eight patients were treated with the MARS method in addition to hemodiafiltration (HDF) and standard medical therapy, and 5 patients were in the control group (HDF and standard medical treatment alone). None of these patients underwent liver transplantation or received a transjugular intrahepatic portosystemic shunt or vasopressin analogues during the observation period. In the MARS group, 5.2 ؎ 3.6 treatments (range, 1 to 10 treatments) were performed for 6 to 8 hours daily per patient. A significant decrease in bilirubin and creatinine levels (P < .01) and increase in serum sodium level and prothrombin activity (P < .01) were observed in the MARS group. Mortality rates were 100% in the control group at day 7 and 62.5% in the MARS group at day 7 and 75% at day 30, respectively (P < .01). We conclude that the removal of albumin-bound substances with the MARS method can contribute to the treatment of type I HRS.

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“…Unlike the MARS, the Prometheus system uses integrated albumin-permeable polysulfone membranes, which allow plasma to be separated from blood [11]. According to this system, hepatic toxins in plasma are removed by direct adsorption to two resin columns [12].…”

Section: Introductionmentioning

confidence: 99%

Development of a Multifunctional Detoxifying Unit for Liver Failure Patients

Lee¹,

Mun²,

Min³

2012

Blood Purif

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Background/Aims: Extracorporeal blood detoxification strategies aimed at supporting impaired liver function have been explored because of the imbalance between donor organs and waiting patients. A limited number of artificial devices are now available clinically, and these are characterized by the use of multistage adsorption procedures in conjunction with hemodialysis, but these features simultaneously increase system complexity and treatment costs. Methods: The authors developed a simpler strategy for liver dialysis based on the use of a multifunctional filter, which enables plasma separation and perfusion in a single unit. Results: Liver dialysis treatments were successfully performed using the devised unit when bovine blood containing uremic and hepatic toxins was circulated. Removal of the solutes under investigation was significant, and reduction ratios of 78% for urea, 98% for creatinine and 91% for bilirubin were achieved. Plasma free hemoglobin levels were reasonably maintained despite prolonged blood recirculation for 5 h, and platelet, hematocrit and hemoglobin levels remained uniform throughout liver dialysis sessions. Conclusion: The devised liver support unit may offer a straightforward and efficient means of cleansing blood for patients with hepatic failure.

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Fractionated Plasma Separation and Adsorption System: A Novel System for Blood Purification to Remove Albumin Bound Substances

Cited by 217 publications

References 23 publications

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

Treatment of hepatorenal syndrome: Lessons from the MARS trial

Development of a Multifunctional Detoxifying Unit for Liver Failure Patients

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