The effect of fractionated plasma separation and adsorption on cerebral amino acid metabolism and oxidative metabolism during acute liver failure

Bjerring, Peter Nissen; Hauerberg, John; Frederiksen, Hans Jørgen; Nielsen, Henning Bay; Clemmesen, J; Larsen, Fin Stolze

doi:10.1016/j.jhep.2012.06.004

Cited by 11 publications

(6 citation statements)

References 23 publications

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“…In contrast to the clinical trial studying the effect of FPSA on oxidative metabolism in patients with ALF conducted by Bjerring and colleagues [5], we found a significant difference between the treated and control groups and a significant decrease in the L/P ratio in the treated group. This could be explained by our use of a well-defined and predictable animal model with a control group, whereas the etiology of ALF varied in the cohort of patients enrolled in the clinical trial.…”

Section: Discussioncontrasting

confidence: 99%

“…The efficacy of FPSA therapy in treatment of ALF-related brain injury is usually monitored by measuring ICP. Recently, the potential of using cerebral microdialysis to monitor cerebral metabolism has been explored in patients with ALF [4], as has the effect of FPSA on the intracerebral oxidative metabolism in ALF [5]. To date, one clinical trial has reported that FPSA had no effect on brain metabolism as measured by the lactate to pyruvate (L/P) ratio, although the patient cohort was small and comprised patients with different etiologies of ALF [5].…”

Section: Introductionmentioning

confidence: 99%

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Cerebral microdialysis reflects the neuroprotective effect of fractionated plasma separation and adsorption in acute liver failure better and earlier than intracranial pressure: a controlled study in pigs

et al. 2013

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BackgroundCerebral edema is a well-recognized and potentially fatal complication of acute liver failure (ALF). The effectiveness of treatments that address intracranial hypertension is generally assessed by measuring intracranial pressure (ICP). The aim of this study was to determine the role of cerebral microdialysis in monitoring the efficacy of fractionated plasma separation and adsorption (FPSA) treatment for ALF. We hypothesized that in ALF cerebral microdialysis reflects the benefits of FPSA treatment on cerebral edema before ICP.MethodsA surgical resection model of ALF was used in 21 pigs. We measured plasma ammonia concentration, brain concentrations of glucose, lactate, pyruvate, glutamate and glutamine, and ICP. Animals were randomized into three groups: in one group eight animals received 6 hours of FPSA treatment 2 hours after induction of ALF; in another group 10 animals received supportive treatment for ALF only; and in the final group three underwent sham surgery.ResultsThe ICP was significantly higher in the ALF group than in the FPSA group 9 hours after surgery. The lactate/pyruvate (L/P) ratio was significantly lower in the FPSA group than the ALF group 5 hours after surgery, before any significant difference in ICP was detected. Indeed, significant changes in the L/P ratio could be observed within 1 hour of treatment. Glutamine levels were significantly lower in the FPSA group than the ALF group between 6 hours and 10 hours after surgery.ConclusionsBrain lactate/pyruvate ratio and concentration of glutamine measured by cerebral microdialysis reflected the beneficial effects of FPSA treatment on cerebral metabolism more precisely and rapidly than ICP in pigs with fulminant ALF. The role of glutamine as a marker of the efficacy of FPSA treatment for ALF appears promising, but needs further evaluation.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cerebral microdialysis reflects the neuroprotective effect of fractionated plasma separation and adsorption in acute liver failure better and earlier than intracranial pressure: a controlled study in pigs

et al. 2013

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“…Additionally, high serum bilirubin levels lead to an inflammatory response and cell apoptosis in the brain, lung, and other organs [ 16 ], which also increases patient mortality. The molecular adsorbent recirculation system and fractionated plasma separation and adsorption have proven to be effective at reducing bilirubin concentrations [ 28 , 29 , 30 , 31 ] and improving patient outcomes in acute and chronic liver failure. For patients with severe hyperbilirubinemia after CHD surgery, the effectiveness and survival benefits of these methods as well as the ideal timing for intervention need further evaluation.…”

Section: Discussionmentioning

confidence: 99%

Severe postoperative hyperbilirubinemia in congenital heart disease

et al. 2021

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Purpose The purpose of our present study was to explore the characteristics and outcomes of congenital heart disease (CHD) patients with severe postoperative hyperbilirubinemia. Methods All patients who underwent cardiopulmonary bypass surgical treatment for CHD and had severe postoperative hyperbilirubinemia (total bilirubin [TB] ≥85.5 μmol/L) in our center between January 2015 and December 2018 were retrospectively screened. Univariate and multivariate analyses were employed to identify risk factors for the study endpoints, including postoperative acute kidney injury (AKI), in-hospital mortality, and long-term mortality. Results After screening, 86 patients were included in our present study. In-hospital mortality was 10.9%. Fifty-one (59.3%) patients experienced AKI, and four (4.7%) patients received continuous renal replacement therapy. Multivariate analysis identified that the peak TB concentration (P = 0.002) and duration of mechanical ventilation (P = 0.008) were independent risk factors for in-hospital mortality, and stage 3 AKI was an independent risk factor for long-term mortality. The optimal cutoff value for peak TB concentration was 125.9 μmol/L. Patients with a postoperative TB level ≥125.9 μmol/L had worse long-term survival. Conclusion Hyperbilirubinemia was a common complication after CHD surgery. CHD patients with severe postoperative hyperbilirubinemia ≥125.9 μmol/L and AKI had a higher risk of mortality.

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“…Some of the amino acids cleared (such as glutamine, phenylalanine, tyrosine and tryptophan) have been directly implicated in the development of HE, suggesting that FPSA may improve this serious condition associated with liver failure. In another study involving patients with ALF monitored by cerebral microdialysis, the authors found the same trend in the removal of aromatic amino acids (especially phenylalanine) from the arterial blood after a single FPSA session, but it was surprisingly without a significant change in the concentrations measured in the microdialyzate [ 78 ]. It should be noted, in this regard, that one of the inclusion criteria was a high risk of intracranial hypertension, but the patients did not need to have clinical encephalopathy.…”

Section: Fractionated Plasma Separation and Adsorption–fpsa (Promethementioning

confidence: 92%

Artificial liver support systems: what is new over the last decade?

Martínez

Bendjelid

2018

Ann. Intensive Care

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The liver is a complex organ that performs vital functions of synthesis, heat production, detoxification and regulation; its failure carries a highly critical risk. At the end of the last century, some artificial liver devices began to develop with the aim of being used as supportive therapy until liver transplantation (bridge-to-transplant) or liver regeneration (bridge-to-recovery). The well-recognized devices are the Molecular Adsorbent Recirculating System™ (MARS™), the Single-Pass Albumin Dialysis system and the Fractionated Plasma Separation and Adsorption system (Prometheus™). In the following years, experimental works and early clinical applications were reported, and to date, many thousands of patients have already been treated with these devices. The ability of artificial liver support systems to replace the liver detoxification function, at least partially, has been proven, and the correction of various biochemical parameters has been demonstrated. However, the complex tasks of regulation and synthesis must be addressed through the use of bioartificial systems, which still face several developmental problems and very high production costs. Moreover, clinical data on improved survival are conflicting. This paper reviews the progress achieved and new data published on artificial liver support systems over the past decade and the prospects for these devices.

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The effect of fractionated plasma separation and adsorption on cerebral amino acid metabolism and oxidative metabolism during acute liver failure

Cited by 11 publications

References 23 publications

Cerebral microdialysis reflects the neuroprotective effect of fractionated plasma separation and adsorption in acute liver failure better and earlier than intracranial pressure: a controlled study in pigs

Cerebral microdialysis reflects the neuroprotective effect of fractionated plasma separation and adsorption in acute liver failure better and earlier than intracranial pressure: a controlled study in pigs

Severe postoperative hyperbilirubinemia in congenital heart disease

Artificial liver support systems: what is new over the last decade?

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