The treatment of acute liver failure with fractionated plasma separation and adsorption system: Experience in 85 applications

Şentürk, Evren; Esen, Figen; Özcan, Perihan Ergin; Rifai, K.; Pınarbaşı, Binnur; Çakar, Nahit; Telci, Lütfi

doi:10.1002/jca.20238

Cited by 39 publications

(15 citation statements)

References 31 publications

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“…It is indeed possible that longer and repeated FPSA sessions might have had a larger impact, but it is most often not straightforward to include a 5-h extra-corporeal blood purification session in the often highly complicated intensive care of ALF patients. However, other centres have been able to treat patients with FPSA repetitively for several days and actually achieved a significant improvement of parameters known to influence the prognosis [25,26]. In a wider perspective, the current trend in the advances in the handling of ALF patients might, eventually, lead to a therapeutic timeframe large enough for a sufficient number of liver assist sessions to achieve clinically relevant effects.…”

Section: Discussionmentioning

confidence: 99%

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

Bjerring

Hauerberg

Frederiksen

et al. 2012

Journal of Hepatology

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Section: Discussionmentioning

confidence: 99%

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

Bjerring

Hauerberg

Frederiksen

et al. 2012

Journal of Hepatology

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“…Sentürk el al. compared the biochemical and clinical parameters for FPSA in patients with ALF and acute-on-chronic liver failure, and showed a significant improvement in the biochemical parameters in HE, although survival rates were not addressed in this study [40]. Similarly, Komardina et al also showed hemodynamic and biochemical improvements with Prometheus in patients with ALF, but without any difference in survival outcomes [41].…”

Section: Fractionated Plasma Separation and Adsorption-fpsa (Prometheus)mentioning

confidence: 70%

Liver Assist Devices for Liver Failure

Mandal¹,

Garlapati²,

Tiongson³

et al. 2021

Liver Pathology

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Historically, mortality rates for liver failure have been high, regardless of the type. With new advancements in liver transplantation (LTx), 1-year survival rates have improved up to 95% in most recent estimates. While some patients may live past the critical period, the majority of patients do not survive the interval period for awaiting LTx or liver regeneration. The function of the liver to detoxify and correct several biochemical parameters has been achieved to some extent through artificial liver support technology, although constant innovations are still being developed for the most optimal liver support device. The complex function of the liver makes it challenging since it does not only detoxify toxic by-products but also participates in numerous other synthetic and metabolic functions of the body. Liver support systems are divided into an artificial liver assist device (ALD) and a bioartificial liver assist device (BLD). ALDs include molecular adsorbent recirculating system (MARS), Prometheus, single-pass albumin dialysis, and selective plasma filtration therapy. These devices work as a blood purification system of the liver. On the other hand, BLD has hepatic cell lines incorporated in its equipment, which aims to function as a complex biological liver system providing support to its biochemical processes. Several clinical and randomized trials have conflicting results on the survival of the patients with acute liver failure (ALF), and the ideal liver support system still seems a far-off goal.

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“…One series described FPSA treatment in 18 patients, eight of them presenting with fulminant hepatitis B. Even though only one liver transplantation was performed, 50% 1-month survival after a mean of three FPSA sessions was observed (15).…”

Section: Clinical Resultsmentioning

confidence: 99%

Fractionated plasma separation and adsorption: current practice and future options

Rifai

2011

Liver International

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Fractionated plasma separation and adsorption (FPSA) is a method of albumin dialysis that is integrated into an extracorporeal liver support device (Prometheus(®)). This concept allows the effective removal of both protein-bound and water-soluble substances without the need for external albumin. Several studies comparing the in vivo extraction capacities of FPSA and molecular adsorbent recirculating system (MARS) concluded that detoxification by FPSA seems to be more effective than by MARS. Overall, FPSA therapy has been shown to be safe. Over the last few years, the anticoagulation protocol for FPSA therapy was optimised by using regional anticoagulation with citrate to avoid clotting of system components. Recently, the results of a large randomised-controlled multicentre trial (HELIOS) have been presented. Survival after 1 and 3 months was evaluated in 145 patients with acute-on-chronic liver failure comparing FPSA therapy with standard medical treatment versus standard medical treatment alone. There was no statistically significant survival benefit for patients undergoing FPSA therapy. However, patients with hepatorenal syndrome type I or MELD score >30 showed a significant survival benefit under FPSA in a predefined subgroup analysis. Furthermore, there have been promising results with FPSA in the treatment of refractory cholestatic pruritus. Regarding acute liver failure, only few data are currently available.

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The treatment of acute liver failure with fractionated plasma separation and adsorption system: Experience in 85 applications

Abstract: FPSA system is a safe and effective detoxification method for patients with liver dysfunction, including ALF. The system is useful as a symptomatic treatment before liver transplantation; in up to 1/3 of the cases, it can even be used as a sole method of treatment.

Cited by 39 publications

References 31 publications

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

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

Liver Assist Devices for Liver Failure

Fractionated plasma separation and adsorption: current practice and future options

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