scholarly journals OC-023 Extracorporeal liver support using UCL-arsenel reduces inflammation, improves haemodynamic function and increase survival time in a porcine paracetamol-induced acute liver failure model

Gut ◽  
2012 ◽  
Vol 61 (Suppl 2) ◽  
pp. A10.2-A10
Author(s):  
P Leckie ◽  
A Proven ◽  
C Thiel ◽  
K Thiel ◽  
M Schenk ◽  
...  
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Survival Time ◽  
Failure Model ◽  
Liver Support ◽  
Extracorporeal Liver Support ◽  
Increase Survival Time

scholarly journals Therapeutic plasma exchange in children with acute liver failure (ALF): is it time for incorporation into the ALF armamentarium?

2021 ◽  
Author(s):  
Emma C. Alexander ◽  
Akash Deep
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Plasma Exchange ◽  
Controlled Trial ◽  
High Volume ◽  
Systemic Circulation ◽  
Liver Support ◽  
Extracorporeal Liver Support ◽  
Randomised Controlled ◽  
Liver Assist Devices

AbstractPaediatric acute liver failure (PALF) is a rare but devastating condition with high mortality. An exaggerated inflammatory response is now recognised as pivotal in the pathogenesis and prognosis of ALF, with cytokine spill from the liver to systemic circulation implicated in development of multi-organ failure associated with ALF. With advances in medical management, especially critical care, there is an increasing trend towards spontaneous liver regeneration, averting the need for emergency liver transplantation or providing stability to the patient awaiting a graft. Hence, research is ongoing for therapies, including extracorporeal liver support devices, that can bridge patients to transplant or spontaneous liver recovery. Considering the immune-related pathogenesis and inflammatory phenotype of ALF, plasma exchange serves as an ideal liver assist device as it performs both the excretory and synthetic functions of the liver and, in addition, works as an immunomodulatory therapy by suppressing the early innate immune response in ALF. After a recent randomised controlled trial in adults demonstrated a beneficial effect of high-volume plasma exchange on clinical outcomes, this therapy was incorporated in European Association for the Study of Liver (EASL) recommendations for managing adult patients with ALF, but no guidelines exist for PALF. In this review, we discuss rationale, timing, practicalities, and existing evidence regarding the use of plasma exchange as an immunomodulatory treatment in PALF. We discuss controversies in delivery of this therapy as an extracorporeal device, and practicalities of use of plasma exchange as a ‘hybrid’ therapy alongside other extracorporeal liver assist devices, before finally reviewing outstanding research questions for the future.

scholarly journals Applying the Molecular Adsorbent Recirculating System (MARS) in the Treatment of Acute Liver Failure (ALF) Case Report

2018 ◽  
Vol 19 (2) ◽  
pp. 189-194
Author(s):  
Jagoda Gavrilovic ◽  
Jelena Djordjevic Velickovic ◽  
Zeljko Mijailovic ◽  
Tatjana Lazarevic ◽  
Aleksandar Gavrilovic ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Clinical Signs ◽  
Caucasian Woman ◽  
Coagulation Disorder ◽  
Liver Support ◽  
Molecular Adsorbent Recirculating System ◽  
Extracorporeal Liver Support ◽  
Molecular Adsorbent

Abstract Acute liver failure (ALF) is a rare but life-threatening illness with multiple organ failure. The short-term mortality rate exceeded 80 % despite modern approaches in treatment. Drugs, infections by hepatic viruses and toxins are the most common causes of ALF. Progressive jaundice, coagulation disorder and hepatic encephalopathy are dominated as a clinical signs of the illness. We present a case of a 36-year-old Caucasian woman hospitalized in ICU due to yellow discoloration of the skin and sclera, severe disseminated coagulopathy and hemodynamic instability. ALF is developed due to Hepatitis B Virus infection, resulting in hepatic toxicity as well as coma. General condition rapidly improved after applying of Molecular Adsorbent Recirculating System (MARS), an extracorporeal liver support system based on albumin dialysis. It is relatively expensive treatment that is used for the patient with hepatic encephalopathy grade 3 or 4 in our institution. In conclusion, an early administration of MARS significantly reveals subjective and objective clinical improvement in the case we presented.

Acute liver failure

2018 ◽  
Vol 1 (1) ◽  
pp. 1-13
Author(s):  
Chalermrat Bunchorntavakul
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Intracranial Hypertension ◽  
Fungal Infections ◽  
Early Recognition ◽  
High Morbidity ◽  
Drug Induced ◽  
Liver Support ◽  
Term Survival ◽  
Extracorporeal Liver Support

Acute liver failure (ALF) is a life threatening condition defined by the evidence of hepatic injury, jaundice, coagulopathy, and encephalopathy in a patient without preexisting cirrhosis and with an illness duration of <26 weeks. The etiologies of ALF are heterogeneous: viral hepatitis being the most common in the East, whereas drug-induced, particularly acetaminophen, being the most common in the West. Over the past decades, the outcomes of ALF have been improving with early recognition and prompt initiation of etiology-specific therapy (especially N-acetylcysteine), complex intensive care protocols and urgent liver transplantation (LT). The most commonly used prognostic scoring systems include King’s College Criteria (more specific) and MELD (more sensitive). Cerebral edema and intracranial hypertension are reasons for high morbidity and mortality in the early phase; hypertonic saline is suggested for patients with high-risk for developing intracranial hypertension (ICH) and when ICH develops, mannitol is recommended as first-line therapy. Bacterial and fungal infections are very common necessitating strict preventive measures, careful surveillance and prompt aggressive antimicrobial therapy. Acute kidney injury develops in 50-70% of patients; mostly reversible in survivors and temporary dialysis is required in about 30% of cases. Overall 1-year survival after LT has been reported to be lower in patients with ALF as compared to those with cirrhosis; however following the first year this trend has been to be reversed and ALF patients have a better long-term survival. Extracorporeal liver support system, such as albumin dialysis and plasmapheresis, may serve as a bridge to LT and may increase LT-free survival in select cases.

scholarly journals The Use of Extracorporeal Liver Support Systems In Acute Decompensated Liver Failure

2021 ◽  
Vol 17 (4) ◽  
pp. 12-21
Author(s):  
R. A. Ibadov ◽  
Ye. L. Ismailov ◽  
S. Kh. Ibragimov
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Organ Failure ◽  
Comparison Group ◽  
Support Systems ◽  
Intensive Therapy ◽  
Multiple Organ ◽  
Main Group ◽  
Liver Support ◽  
Extracorporeal Liver Support

The aim of the study: to evaluate the efficacy of extracorporeal liver support systems in patients with acute liver failure of various etiologies.Material and methods. The study included 117 patients with acute liver failure of various etiologies. The main group consisted of 71 patients who received complex intensive therapy, including MARS-therapy and hemodiafiltration. The comparison group included 46 patients who received albumin dialysis (24 patients) and hemodiafiltration (22 patients) alone. The mean age of the patients was 34±5.6 years, the majority (56.4%) were men. Dynamic assessment of patients' severity was performed using Sequential Organ Failure Assessment (SOFA) and Model for End-Stage Liver Disease (MELD) scales.Results. A more significant reduction of SOFA and MELD scores was noted as early as by day 10 of intensive therapy in the main group with sequential use of extracorporeal liver detoxification methods — to 2.7±0.2 vs. 8.3±0.5 points (P=0.021) on SOFA and to 16.7±0.4 vs. 23.4±1.4 points (P=0.023) MELD scales. The use of a comprehensive approach to extracorporeal detoxification in acute decompensated liver failure increased the regression rate of multiple organ failure from 51.2 to 74.6% and reduced mortality from 47.8 to 25.4% (χ2=6.266; df=1; P=0.013). At the same time, the cumulative proportion of survivors depending on the type of complication within 30 days was 88.4% in the main group and 69.0% in the comparison group (χ2=4.164; df=1; P=0.042).Conclusion. A comprehensive approach to extracorporeal detoxification is highly effective, providing a more significant reduction of SOFA and MELD scores, increasing the proportion of regression of multiple organ dysfunction and reducing mortality.

Sign in / Sign up

Export Citation Format

Share Document