Use of Mars in the Treatment of Acute Liver Failure. Preliminar Monocentric Experience

Novelli, G.; Rossi, Massimo; Pretagostini, R.; Iappelli, M; Poli, L.; Pietra, F. Della; Rocca, G Della; Berloco, P.B.; Nicuolo, A. Di; Peritore, D.; Colonnello, M; Cancnini, Cinzia; Attili, Adolfo Maria; Cortesini, Raffaello

doi:10.1097/00002480-200003000-00335

Cited by 12 publications

(11 citation statements)

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“…Urine sodium was accessible in 3 patients before the onset of therapy. It was below 20 mmol/L in all cases (12,8, and 1 mmol/ L). Clinical and biochemical baseline characteristics are shown in Table 1.…”

Section: Patientsmentioning

confidence: 74%

“…More than 800 patients were treated, mostly for acute decompensation of chronic liver disease (acute on chronic hepatic failure, AoCHF) with alcoholic liver disease and viral hepatitis B or C as underlying diseases (4,5). Moreover, acute hepatic failure, primary non-dysfunction after liver transplantation, postoperative liver insufficiency following liver resection or heart surgery, secondary liver failure as a complication of burn injuries, trauma, sepsis, heart failure, and cholestatic syndromes (i.e., Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis) were treated (6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

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confidence: 99%

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Improvement of Multiple Organ Functions in Hepatorenal Syndrome During Albumin Dialysis with the Molecular Adsorbent Recirculating System

Mitzner

Klammt

Peszynski

et al. 2001

Therapeutic Apheresis

115

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Recently, significant improvement of renal function and prolongation of survival were reported in hepatorenal syndrome (HRS) patients treated with the Molecular Adsorbent Recirculating System (MARS). As no impact on extrarenal organ function was documented, this trial looked into multiple organ function changes during MARS in HRS patients. Eight HRS patients (4 male, mean age 42. 1 years, range 30–58, all United Network for Organ Sharing [UNOS] status 2A) were treated intermittendly 4–14 times (total 47, mean 5.9 ± 3.4) between 4 and 8 h/single treatment. The following changes were observed pre‐ and posttreatment: bilirubin 466 ± 146 to 284 ± 134 γmol/L, creatinine 380 ± 182 to 163 ± 119 μmol/L, urea 26.4 ± 10.3 to 12.9 ± 4.9 mmol/L, plasma sodium 127.5 ± 7.7 to 137.5 ± 4.8 mmol/L (all p < 0.01). Mean arterial pressure (MAP) increased from 71.9 ± 12.8 to 95.6 ± 7.8 Torr (p < 0.001). Oliguria or anuria, present in all patients, was successfully reverted. Ascites, present in all patients, was not detectable after the treatment period. The hepatic encephalopathy grade decreased from 2.8 ± 0.8 to 0.8 ± 0.7 (p < 0.0001). Child‐Index decreased from 13.25 ± 1.3 to 9.4 ± 1.8 (p < 0.001). The hospital survival rate was 62%. One man underwent successful liver transplantation 18 months after the treatment. We conclude that MARS can improve multiple organ functions in patients with HRS.

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Section: Patientsmentioning

confidence: 74%

mentioning

confidence: 99%

Improvement of Multiple Organ Functions in Hepatorenal Syndrome During Albumin Dialysis with the Molecular Adsorbent Recirculating System

Mitzner

Klammt

Peszynski

et al. 2001

Therapeutic Apheresis

115

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“…This method of removing albumin-binding toxins and water-soluble substances would result in hepatic-encephalopathy and in improvements in kidney and liver function. 97,98 2. HSA is widely distributed in the plasma compartment and easily related to the immune system.…”

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confidence: 99%

Ligand binding strategies of human serum albumin: How can the cargo be utilized?

et al. 2009

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Human serum albumin (HSA), being the most abundant carrier protein in blood and a modern day clinical tool for drug delivery, attracts high attention among biologists. Hence, its unfolding/refolding strategies and exogenous/endogenous ligand binding preference are of immense use in therapeutics and clinical biochemistry. Among its fellow proteins albumin is known to carry almost every small molecule. Thus, it is a potential contender for being a molecular cargo/or nanovehicle for clinical, biophysical and industrial purposes. Nonetheless, its structure and function are largely regulated by various chemical and physical factors to accommodate HSA to its functional purpose. This multifunctional protein also possesses enzymatic properties which may be used to convert prodrugs to active therapeutics. This review aims to highlight current overview on the binding strategies of protein to various ligands that may be expected to lead to significant clinical applications.

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“…In 2001, when we began using MARS therapy, it was unclear which patients would benefit from the treatment. The only available data on MARS at the time were from a few small studies conducted on patients with AOCLF [19][20][21][22][23][24] . Therefore, data with the planned protocol were collected prospectively from every MARStreated patient in our ICU.…”

Section: Discussionmentioning

confidence: 99%

Survival predictors in patients treated with a molecular adsorbent recirculating system

Kantola¹,

Koivusalo²,

Parmanen³

et al. 2009

WJG

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AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system (MARS). METHODS:MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery, and as a bridge to liver transplantation (LTX). We analyzed the 1-year outcomes of 188 patients treated with MARS, from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic, clinical and laboratory parameters were recorded before and after each treatment. One-year survival and the number of LTXs were recorded. Logistic regression analysis was performed to determine factors predicting survival. RESULTS:The study included 113 patients with acute liver failure (ALF), 62 with acute-on-chronic liver failure (AOCLF), 11 with graft failure (GF), and six with miscellaneous liver failure. LTX was performed for 29% of patients with ALF, 18% with AOCLF and 55% with GF. The overall 1-year survival rate was 74% for ALF, 27% for AOCLF, and 73% for GF. The poorest survival rate, 6%, was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis, whereas, patients with enlarged and steatotic liver had 55% survival. The etiology of liver failure was the most important predictor of survival (P < 0.0001). Other prognostic factors were encephalopathy (P = 0.001) in paracetamol-related ALF, coagulation factors (P = 0.049) and encephalopathy (P = 0.064) in non-paracetamol-related toxic ALF, and alanine aminotransferase (P = 0.013) and factor V levels (P = 0.022) in ALF of unknown etiology. CONCLUSION:The etiology of liver disease was the most important prognostic factor. MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.

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Use of Mars in the Treatment of Acute Liver Failure. Preliminar Monocentric Experience

Cited by 12 publications

References 0 publications

Improvement of Multiple Organ Functions in Hepatorenal Syndrome During Albumin Dialysis with the Molecular Adsorbent Recirculating System

Improvement of Multiple Organ Functions in Hepatorenal Syndrome During Albumin Dialysis with the Molecular Adsorbent Recirculating System

Ligand binding strategies of human serum albumin: How can the cargo be utilized?

Survival predictors in patients treated with a molecular adsorbent recirculating system

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