Motor cortex excitability in severe liver failure: effects of Molecular Adsorbent Recycling System

Oliviero, Antonio; Mercurio, G; Pilato, Fabio; Accurso, A.; Saturno, E.; Pennisi, Manuela; Mignani, V.; Gaspari, Romolo; Gasbarrini, A.; Campli, C. Di; G, Caminiti; Gentiloni, N.; Lazzaro, V. Di

doi:10.1055/s-2001-919040

Cited by 5 publications

(1 citation statement)

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“…Several reports on the use of MARS in patients with ALF of various etiology have shown a successful bridge to transplant and, sometimes, a recovery of native liver function, by a decrease in bilirubin, ammonia level and HE score and an increase in Fisher ratio [41][42][43][44]36]. Moreover, in four cases of fulminant Wilson's disease the removal of copper by albumin dialysis was accompanied by a significant clinical recovery up to the liver transplant [45][46].…”

Section: Results From Clinical Trialsmentioning

confidence: 99%

Advances in Extracorporeal Detoxification by MARS Dialysis in Patients with Liver Failure

Campli

Verme

Andrisani

et al. 2003

CMC

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Although liver transplantation has become standard procedure for patients with liver failure, a number of issues in the management of these patients remains to be addressed. Alternative approaches have been tested, such as hepatocytes containing liver-support systems and filtration devices. However, the replacement of detoxification has been difficult, as the majority of toxins accumulating in liver failure is albumin-bound. Albumin dialysis (MARS system) is characterized by the specific removal of albumin-bound toxins through an innovative membrane transport. In particular, the albumin acts as a specific molecular adsorbent that is regenerated on line in a recycling system. Nowadays MARS represents the most frequently used liver support system. This treatment has been shown to remove albumin-bound molecules, such as bilirubin, bile acids, aromatic amino acids and copper. The removal of these toxins is clinically accompanied with an improvement of liver, cardiovascular and renal functions and hepatic encephalopathy. In several trials MARS was found to improve the clinical situation in patients with acute exacerbation of chronic liver failure and acute hepatic failure, but also in hepatorenal syndrome and primary graft non function or chronic rejection after liver transplantation. In summary, a critical analysis of the literature confirms that MARS device can be a safe therapeutic choice to achieve a better clinical outcome, and, sometimes, a survival advantage in patients with liver failure, even if a multi-center randomized trial is the only reliable way to enforce today's results. Further advances in the MARS components will definitively state whether albumin dialysis may represent the future in the field of artificial liver devices.

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Section: Results From Clinical Trialsmentioning

confidence: 99%

Advances in Extracorporeal Detoxification by MARS Dialysis in Patients with Liver Failure

Campli

Verme

Andrisani

et al. 2003

CMC

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The Molecular Adsorbents Recycling System as a Liver Support System Based on Albumin Dialysis: A Summary of Preclinical Investigations, Prospective, Randomized, Controlled Clinical Trial, and Clinical Experience from 19 Centers

Stange¹,

Hassanein²,

et al. 2002

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Artificial liver support aims to prolong survival time of patients with liver failure by detoxification. Albumin as a molecular adsorbent in dialysis solution is capable of attracting even tightly albumin-bound toxins from blood into the dialysate if a specific dialysis membrane is used and if the albumin's binding sites are on-line-purified by a sorbent/dialysis-based recycling system (i.e., molecular adsorbents recycling system, or MARS). The MARS technology has been shown to remove water-soluble and albumin-bound toxins and to provide renal support in case of renal failure. Fourteen centers have reported that MARS treatment improved mental status of patients with liver failure and hepatic encephalopathy. In treating liver failure and cholestasis, MARS was associated with hemodynamic stabilization, improvement of hepatic and kidney function, and disappearance of pruritus. In hepatic failure and hepatorenal syndrome, a prospective, randomized, controlled trial of MARS treatment was able to prolong survival time significantly. MARS has been used in 26 patients with acute liver failure or primary graft dysfunction. Nineteen centers reporting on 103 patients have shown that MARS treatment is safe, easy to handle, feasible, and effective.

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Albumin dialysis using the molecular adsorbent recirculating system

Mitzner

Stange

Klammt

et al. 2001

Current Opinion in Nephrology and Hypertension

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Liver support systems based on either dialysis, filtration, and adsorption or plasmaperfusion over hepatocytes have been tested clinically with varying success. A new approach in this field is the selective removal of albumin-bound end products of metabolism. This can be achieved in a high-flux dialysis setting by the addition of human serum albumin as a molecular adsorbent to the dialysate with subsequent recirculation of the dialysate over sorbents (molecular adsorbent recirculating system). The current knowledge about the albumin dialysis molecular adsorbent recirculating system is reviewed in this article.

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Motor cortex excitability in severe liver failure: effects of Molecular Adsorbent Recycling System

Cited by 5 publications

References 0 publications

Advances in Extracorporeal Detoxification by MARS Dialysis in Patients with Liver Failure

Advances in Extracorporeal Detoxification by MARS Dialysis in Patients with Liver Failure

The Molecular Adsorbents Recycling System as a Liver Support System Based on Albumin Dialysis: A Summary of Preclinical Investigations, Prospective, Randomized, Controlled Clinical Trial, and Clinical Experience from 19 Centers

Albumin dialysis using the molecular adsorbent recirculating system

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