Similarities, Differences, and Potential Synergies in the Mechanism of Action of Albumin Dialysis Using the MARS Albumin Dialysis Device and the CytoSorb Hemoperfusion Device in the Treatment of Liver Failure

Dominik, Adrian; Stange, Jan

doi:10.1159/000508810

Cited by 46 publications

(39 citation statements)

References 41 publications

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“…The mean age in our study group was 34 ± 14 years. The median number of organ dysfunctions was 3 [2][3][4][5][6] with 75% of patients having grade III or IV hepatic encephalopathy. The mean SOFA score before the start of CRRT was 12.0 ± 2.1.…”

Section: Resultsmentioning

confidence: 99%

“…2 The use of haemoadsorption has recently been introduced in clinical practice for managing inflammation in different clinical scenarios including sepsis, cardiac surgery or acute pancreatitis. 3,4 The theoretical benefits in this extracorporeal therapy in ALF has been tested in two experimental studies that have demonstrated an improvement of both liver functional tests and near complete removal of proinflammatory cytokines 5,6 but these results need further assessment in clinical trials. To date, only a few clinical cases have been published showing the potential clinical benefits of haemoadsorption in liver failure 7,8 showing an improvement in biochemical parameters.…”

Section: Introductionmentioning

confidence: 99%

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Haemoadsorption by CytoSorb® in patients with acute liver failure: A case series

et al. 2020

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Acute liver failure (ALF) is a life-threatening disease associated with multi-organ failure and increased mortality. Severe inflammation is now considered the main pathophysiological mechanism for organ dysfunction, thus rebalancing pro- and anti- inflammatory cytokines may improve liver function and outcome. The aim of this study was to assess the clinical effects of a haemoadsorption column on biochemical parameters in patients with ALF. We prospectively included 28 patients with ALF who were treated with three consecutive sessions of continuous venovenous haemofiltration in combination with CytoSorb®. Our results show an improvement in liver functional tests and a decrease in Creactive protein. Thrombocytopenia remains one of the most important side effects of this treatment and careful consideration should be made before initiation of treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Haemoadsorption by CytoSorb® in patients with acute liver failure: A case series

et al. 2020

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“…Other blood purification methods, such as CytoSorb ™ therapy, also seem promising [59,60], but they have not yet been evaluated in a randomized setting. Nevertheless, according to a recent in vitro experimental model, Cyto-Sorb hemoperfusion leads to an initially faster removal of cytokines, like TNF-α and IL-6, as well as more effective reduction of albumin-bound toxins, such as indirect bilirubin and bile acids, compared to MARS [61].…”

Section: Discussionmentioning

confidence: 99%

Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis

Ocskay

Kanjo

Gede

et al. 2021

Ann. Intensive Care

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Background The role of artificial and bioartificial liver support systems in acute-on-chronic liver failure (ACLF) is still controversial. We aimed to perform the first network meta-analysis comparing and ranking different liver support systems and standard medical therapy (SMT) in patients with ACLF. Methods The study protocol was registered with PROSPERO (CRD42020155850). A systematic search was conducted in five databases. We conducted a Bayesian network meta-analysis of randomized controlled trials assessing the effect of artificial or bioartificial liver support systems on survival in patients with ACLF. Ranking was performed by calculating the surface under cumulative ranking (SUCRA) curve values. The RoB2 tool and a modified GRADE approach were used for the assessment of the risk of bias and quality of evidence (QE). Results In the quantitative synthesis 16 trials were included, using MARS®, Prometheus®, ELAD®, plasma exchange (PE) and BioLogic-DT®. Overall (OS) and transplant-free (TFS) survival were assessed at 1 and 3 months. PE significantly improved 3-month OS compared to SMT (RR 0.74, CrI: 0.6–0.94) and ranked first on the cumulative ranking curves for both OS outcomes (SUCRA: 86% at 3 months; 77% at 1 month) and 3-month TFS (SUCRA: 87%) and second after ELAD for 1-month TFS (SUCRA: 76%). Other comparisons did not reach statistical significance. QE was moderate for PE concerning 1-month OS and both TFS outcomes. Other results were of very low certainty. Conclusion PE seems to be the best currently available liver support therapy in ACLF regarding 3-month OS. Based on the low QE, randomized trials are needed to confirm our findings for already existing options and to introduce new devices.

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“…Acute forms of liver dysfunction and failure also share the pathophysiological features of dysregulated inflammatory response with sepsis, which serves as the basis of the rationale hemoadsorption in liver dysfunction [ 12 , 13 , 14 ]. There are some case reports, case series, and in vitro data indicating effective removal of bilirubin, bile acids, and ammonia from the blood by using hemoadsorption [ 15 , 16 , 17 , 18 ]. In a recent in vitro study, CytoSorb was also found superior to albumin dialysis (Molecular Adsorbent Recirculating System: MARS) as far as bilirubin, bile acid, ammonia, and cytokine removal are concerned [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Hemoadsorption in ‘Liver Indication’—Analysis of 109 Patients’ Data from the CytoSorb International Registry

Ocskay

Tomescu

Faltlhauser

et al. 2021

JCM

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Background: Our aim is to report the results of the ‘liver indication’ subset of patients in the CytoSorb International Registry. Methods: Structured data were recorded. Treatment characteristics and changes from T1 (start of hemoadsorption) to T2 (termination) were evaluated with a special focus on bilirubin, C-reactive protein, procalcitonin, interleukin-6, platelet levels, SOFA scores, mortality, and subjective assessment by the attending physicians. Results: Until January 2021, from the total 1434 patients, 109 (age: 49.2 ± 17.1 years, 57.8% males) received treatment for hyperbilirubinemia. APACHE II-predicted mortality was 49.6 ± 26.8%. In the study, 91% of patients were alive at the termination of hemoadsorption and improvement was observed by the physicians in 75 cases. Overall, 65 (59.6%) patients died in the hospital, and 60 (55.0%) died in the ICU. Patients received a median of two treatments for a median of 43 h (interquartile range: 24–72 h) in total. Serum bilirubin levels reduced significantly to −4.6 (95% CI: −6.329 to −2.8) mg/dL. Thrombocytopenia was reported in four patients as an adverse event. Conclusions: We report the largest case series on hemoadsorption for ‘liver indication’ from the CytoSorb International Registry. The finding of significant bilirubin removal observed in our study could have substantial impact in designing and executing further studies on the effects of hemoadsorption in liver dysfunction, which are certainly warranted.

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Similarities, Differences, and Potential Synergies in the Mechanism of Action of Albumin Dialysis Using the MARS Albumin Dialysis Device and the CytoSorb Hemoperfusion Device in the Treatment of Liver Failure

Cited by 46 publications

References 41 publications

Haemoadsorption by CytoSorb® in patients with acute liver failure: A case series

Haemoadsorption by CytoSorb® in patients with acute liver failure: A case series

Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis

Hemoadsorption in ‘Liver Indication’—Analysis of 109 Patients’ Data from the CytoSorb International Registry

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