Novel use of Cytosorb™ haemadsorption to provide biochemical control in liver impairment

Abstract

We describe the use of Cytosorb TM , a synthetic extracorporeal haemoperfusion adsorption column, in the management of two patients with drug induced cholestasis and a third with alcoholic hepatitis and subsequent acute on chronic liver failure. Cytosorb was used in these patients to remove bilirubin and bile acids by supporting impaired excretory hepatic function, alleviating symptoms with the intention of serving as a bridge to endogenous recovery. The first two cases demonstrate favourable biochemical and symptomatic responses; the third case demonstrated a good biochemical response but subsequently died from the complications of multiple organ failure. These cases suggest Cytosorb TM be evaluated as an adjunct to support liver excretory functions in other arenas, such as acute liver failure or overdose. It remains unclear whether extracorporeal therapies removing liver toxins allow faster or more complete spontaneous recovery of endogenous function.

Removal of Bilirubin with a New Adsorbent System: In Vitro Kinetics

“…We first tested the solution's stability because of possible bilirubin degradation [19], concluding that it is important to avoid light exposure of the solution and control temperatures during the experiment.…”

“…A new sorbent, Cytosorb ® , has demonstrated its ability to modulate inflammatory mediators in septic shock [12][13][14][15], as well as bilirubin and bile acids levels [12,13,[17][18][19]. A comparative study of various liver support techniques [18] showed an impressive bilirubin and bile acids MB with Cytosorb, compared to the other systems, thanks to continuous adsorption, up to 24 h, directly from the blood, whereas the other techniques work only for 4-6 h on plasma.…”

“…Experimental and clinical studies have widely demonstrated their ability to modulate inflammatory mediators in septic shock [14][15][16]; preliminary case reports in systemic inflammatory response and septic shock [12,13], as well as recent experiences [17][18][19], have shown that the sorbent also reduces bilirubin and bile acids. This combined action may be helpful in supporting liver dysfunctions.…”

Options in extracorporeal support of multiple organ failure

“…Hemadsorption. A few case reports and small case-series suggest that bilirubin is eliminated by the hemadsorption device CytoSorb [40]. Based on the methodology, so far no conclusions about an improved outcome can be drawn so far.…”

Applications of Cytosorb in clinical practice

“…The case of cardiac surgery patient showed a bilirubin drop from 24.5 mg/dL to 10.8 mg/dL after three days of Cytosorb therapy [32]. The Cytosorb was reported to be useful in patient with hyperbilirubinemia due to hepatic failure [33], in drug-induced cholestasis, alcoholic hepatitis [34], and cholestasis in sepsis [35]. It was used successfully in a liver cirrhosis patient with a pre-existing hepatitis C infection [36].…”