Molecular adsorbent recirculating system treatment for patients with liver failure: the Hong Kong experience

Chiu, Alexander S.; Chan, Lina Mun Yee; Fan, Sheung Tat

doi:10.1111/j.1478-3231.2006.01293.x

Cited by 41 publications

(23 citation statements)

References 39 publications

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“…137 The severity of the PHLF should be followed using laboratory values such as INR, platelets, ammonia, bilirubin, and creatinine. Resuscitative measures and organ support provide the optimal environment for liver regeneration.…”

Section: Treatment Of Post-hepatectomy Liver Failurementioning

confidence: 99%

Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

Lafaro

Buettner

Maqsood

et al. 2015

Journal of Gastrointestinal Surgery

103

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Section: Treatment Of Post-hepatectomy Liver Failurementioning

confidence: 99%

Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

Lafaro

Buettner

Maqsood

et al. 2015

Journal of Gastrointestinal Surgery

103

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“…But only one patient survived. Also a study from Hong Kong Hospitals showed a poor outcome in patients with PHLF and MARS therapy despite of improvement in biochemical parameters [33]. …”

Section: Treatment Of Phlf Remains Difficultmentioning

confidence: 99%

Posthepatectomy Liver Failure

et al. 2012

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Background: Posthepatectomy liver failure (PHLF) is one of the most serious complications after liver resection and is still reported in up to 8% after liver resection. Aims: To provide an overview about the current status of risk analysis and definition of PHLF. Prevention and treatment is also discussed. Methods: A literature review was carried out on PubMed using the terms ‘liver failure’, ‘posthepatectomy’ and ‘liver surgery’ to search relevant papers. Discussion: PHLF remains a serious problem in patients undergoing major liver resection. Adequate preoperative risk assessment and an optimal postoperative treatment are essential for PHLF prevention.

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“…Large, randomized, controlled trials did, however, fail to demonstrate a statistically significant survival benefit 14, 15. In the PHLF situation, only a few single‐center experiences have addressed the use of MARS as a rescue treatment option,16, 17, 18, 19, 20 and all of them suffer from heterogeneous patient groups and a lack of standardized treatment protocols. Recently, we reported our retrospective experience with MARS for PHLF at two tertiary referral centers where we found a trend toward improved 90‐day and long‐term survival in patients who received several MARS treatments early in the postoperative course 21.…”

Section: Introductionmentioning

confidence: 99%

The molecular adsorbent recirculating system in posthepatectomy liver failure: Results from a prospective phase I study

Gilg

Sparrelid

Saraste³

et al. 2018

Hepatology Communications

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Posthepatectomy liver failure (PHLF) represents the single most important cause of postoperative mortality after major liver resection, yet no effective treatment option is available. Extracorporeal liver support devices might be helpful, but systematic studies are lacking. Accordingly, we aimed to assess the safety and feasibility of the Molecular Adsorbent Recirculating System (MARS) in patients with PHLF. Between December 2012 and May 2015, a total of 206 patients underwent major or extended hepatectomy, and 10 consecutive patients with PHLF (according to the Balzan 50:50 criteria) were enrolled into the study. MARS treatment was initiated on postoperative day 5‐7, and five to seven consecutive treatment sessions were completed for each patient. In total, 59 MARS cycles were implemented, and MARS was initiated and completed without major complications in any patient. However, 1 patient developed an immense asymptomatic hyperbilirubinemia (without encephalopathy), 1 had repeated clotting problems in the MARS filter, and 2 patients experienced access problems with the central venous line. Otherwise, no adverse events were observed. In 9 patients, the bilirubin level and international normalized ratio decreased significantly (P < 0.05) during MARS treatment. The 60‐ and 90‐day mortality was 0% and 10%, respectively. Among the 9 survivors, 4 still had liver dysfunction at 90 days postoperatively. Five patients were alive 1 year postoperatively without any signs of liver dysfunction or disease recurrence. Conclusion: The use of MARS in PHLF is feasible and safe and improves liver function in patients with PHLF. In the present study, 60‐ and 90‐day mortality rates were unexpectedly low compared to a historical control group. The impact of MARS treatment on mortality in PHLF should be further evaluated in a randomized controlled clinical trial. (Hepatology Communications 2018;2:445‐454)

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Molecular adsorbent recirculating system treatment for patients with liver failure: the Hong Kong experience

Cited by 41 publications

References 39 publications

Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

Posthepatectomy Liver Failure

The molecular adsorbent recirculating system in posthepatectomy liver failure: Results from a prospective phase I study

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