The successful application of hemoadsorption for extracorporeal liver support in a child with acute liver failure

Abstract

A 6-year-old boy developed acute liver failure with hepatic coma due to drug rash with eosinophilia and systemic symptoms (DRESS) after multiple antibiotics exposure. He had hyperbilirubinemia, elevated serum bile acids and hyperammonemia with peak serum levels of total bilirubin, direct bilirubin, bile acids and ammonia measuring 418, 328, 174, and 172 μmol/L respectively. In addition to the use of systemic steroid and other supportive therapy, he also received three sessions of hemoadsorption using the Cytosorb® column incorporated into the continuous renal replacement therapy circuit as extracorporeal liver support for a total duration of 75 h, which brought down his serum levels of total bilirubin to 119 μmol/L, bile acids to 58 μmol/L, and ammonia to 55 μmol/L. His conscious level gradually regained coupling an improvement of liver function. Except for mild thrombocytopenia and electrolyte disturbances, the therapy was well tolerated with no major complication encountered. Our case demonstrated that hemoadsorption can be safely employed as an adjunctive extracorporeal liver support modality in children with acute liver failure. The potential role and technical concerns of applying such technique in pediatric patients requires further evaluation in future studies.

Correlation between Bilirubin Elimination with the Cytokine Adsorber CytoSorb® and Mortality in Critically Ill Patients with Hyperbilirubinemia

“…The use of CS did not have a significant effect in this model either. This gives the indication that while a laboratory effect can be gained [26, 27], long-term effects are not achievable.…”

“…The use of CS did not have a significant effect in this model either. This gives the indication that while a laboratory effect can be gained [26,27], long-term effects are not achievable. In summary, the use of CS did not reduce mortality in our population, which might be explained by several aspects.…”

The potential role of extracorporeal cytokine removal with CytoSorb® as an adjuvant therapy in Acute Respiratory Distress Syndrome

“…While the majority of studies investigating CytoSorb report no serious adverse events, 81 there are isolated cases where thrombocytopenia has been observed. 82,83 Nevertheless, thrombocytopenia may occur as a potential consequence of any extracorporeal circulation procedure, including the use of CytoSorb. 84 The issue of CytoSorb's potential impact on pharmacokinetics, specifically with regards to drug absorption, is an ongoing topic of interest.…”

The application of hemoadsorption for hyperbilirubinemia and its impact on bilirubin removal kinetics in critically ill children

“…11 There are also case reports and series demonstrating its capability of bilirubin removal among critically ill patients including children. 12–14…”

“…11 There are also case reports and series demonstrating its capability of bilirubin removal among critically ill patients including children. [12][13][14] The removal efficacy of bilirubin is frequently used to compare the performance of the EBP modalities. 9 As reports from pediatric patients on applying CKRT and EBP (especially HA) for bilirubin removal remain scarce, the efficacy and removal kinetics is largely unknown.…”