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.

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.

Acute liver failure

2018 ◽  
Author(s):  
Naresh P Shanmugam ◽  
Sanjay Bansal
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Support Systems ◽  
Liver Support

The chapter on acute liver failure includes the definition, aetiology, and management of this condition. It discusses the frequently associated complications (neurological, haemodynamic, coagulopathy, infectious, and metabolic) and its prognosis, as well as the role of liver transplantation and liver support systems in its management.

Removal of Bile Acids by Two Different Extracorporeal Liver Support Systems in Acute-on-Chronic Liver Failure

ASAIO Journal ◽  
2007 ◽  
Vol 53 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Vanessa Stadlbauer ◽  
Peter Krisper ◽  
Ulrich Beuers ◽  
Bernd Haditsch ◽  
Daniel Schneditz ◽  
...  
Keyword(s):  
Liver Failure ◽  
Bile Acids ◽  
Support Systems ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Liver Support ◽  
Extracorporeal Liver Support

scholarly journals HMGB1 and Extracellular Histones Significantly Contribute to Systemic Inflammation and Multiple Organ Failure in Acute Liver Failure

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Runkuan Yang ◽  
Xiaoping Zou ◽  
Jyrki Tenhunen ◽  
Tor Inge Tønnessen
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Systemic Inflammation ◽  
Cell Injury ◽  
Inflammatory Responses ◽  
Multiple Organ ◽  
Hepatocyte Regeneration ◽  
Extracellular Histones

Acute liver failure (ALF) is the culmination of severe liver cell injury from a variety of causes. ALF occurs when the extent of hepatocyte death exceeds the hepatic regenerative capacity. ALF has a high mortality that is associated with multiple organ failure (MOF) and sepsis; however, the underlying mechanisms are still not clear. Emerging evidence shows that ALF patients/animals have high concentrations of circulating HMGB1, which can contribute to multiple organ injuries and mediate gut bacterial translocation (BT). BT triggers/induces systemic inflammatory responses syndrome (SIRS), which can lead to MOF in ALF. Blockade of HMGB1 significantly decreases BT and improves hepatocyte regeneration in experimental acute fatal liver injury. Therefore, HMGB1 seems to be an important factor that links BT and systemic inflammation in ALF. ALF patients/animals also have high levels of circulating histones, which might be the major mediators of systemic inflammation in patients with ALF. Extracellular histones kill endothelial cells and elicit immunostimulatory effect to induce multiple organ injuries. Neutralization of histones can attenuate acute liver, lung, and brain injuries. In conclusion, HMGB1 and histones play a significant role in inducing systemic inflammation and MOF in ALF.

scholarly journals Extracorporal methods for liver failure treatment

2014 ◽  
Vol 95 (1) ◽  
pp. 75-79 ◽  
Author(s):  
D E Kutepov
Keyword(s):  
Liver Failure ◽  
Support Systems ◽  
Isolated Hepatocytes ◽  
Liver Support ◽  
Failure Treatment ◽  
Molecular Adsorbent Recirculating System ◽  
Extracorporeal Liver Support ◽  
Long Time ◽  
Biological Methods ◽  
Molecular Adsorbent

A mortality rate in patients with liver failure remains high. Currently the main causes for liver failure are viral hepatitis and alcoholic liver disease. As a result of liver detoxification malfunction a number of complications, including hepatic encephalopathy, hepatorenal syndrome, circulatory disorders develop. Different types of extracorporeal therapies and their combination are used to treat the liver failure for a long time. Figuratively, extracorporeal liver support systems can be divided into two groups: biological and non-biological. Biological methods are based on the use of isolated hepatocytes suspension. Non-biological methods include dialysis, hemofiltration, plasma exchange, hemosorption, Molecular Adsorbent Recirculating System (MARS) and fractionated plasma separation and adsorption (FPSA or Prometheus). Modern technologies allowed to combine liver support systems into a whole and to create an additional method of liver failure treatment — Molecular Adsorbent Recirculating System (MARS). Currently, MARS is a promising trend of liver failure treatment, as it allows support the liver function for a long time until restored or an optimal donor will be found.

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.

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