Extracorporal methods for liver failure treatment

Abstract

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.

Keywords

liver failure / extracorporeal therapy / Molecular Adsorbent Recirculating System (MARS)

References

[1] Бокерия Л.А., Ярустовский М.Б., Гептнер Р.А. и др. Альбуминовый диализ в комплексной интенсивной терапии больных после кардиохирургических операций. Первый собственный опыт // Анестезиол. и реаниматол. — 2005. — №2. — С. 78–83.

[2] Ивашкин В.Т. Болезни печени и желчевыводящих путей. — М.: М-Вести, 2005. — 536 с.

[3] Ивашкин В.Т., Маевская М.В. Алкогольно-вирусные заболевания печени. — М.: Литтерра, 2007. — 160 с.

[4] Кутепов Д.Е., Пасечник И.Н., Попов А.В. и др. Роль и место альбуминового диализа в лечении больных с печёночной недостаточностью // Анестезиол. и реаниматол. — 2010. — №2. — С. 53–58.

[5] Лопухин Ю.М., Молоденков М.Н. Гемосорбция. 2-е изд. перераб. и доп. — М.: Медицина, 1985. — 288 с.

[6] Надинская М.Ю. Печёночная энцефалопатия: патогенетические подходы к лечению // Consil. Med. — 2004. — №2. — С. 12–16.

[7] Пасечник И.Н., Кутепов Д.Е. Печёночная недостаточность: современные методы лечения. — М.: МИА, 2009. — 240 с.

[8] Подымова С.Д. Болезни печени. — М.: Медицина, 1998. — 704 с.

[9] Радченко В.Г., Шабров А.В., Зиновьева Е.Н. Основы клинической гепатологии. Заболевания печени и билиарной системы. — СПб.: Диалект; М.: Бином, 2005. — 864 с.

[10] Топорков А.С. Комплексная терапия печёночной энцефалопатии // Consil. med. Приложение хирургия (2). — 2005. — №2. — С. 48–51.

[11] Шерлок Ш., Дули Дж. Заболевания печени и жёлчных путей. — М.: ГЭОТАР-Мед, 2002. — 864 с.

[12] Butterworth R.F. Pathophysiology of hepatic encepha­lopathy: the concept of synergism // Hepatol. Reseach. — 2008. — Vol. 38, N 1. — P. 116–121.

[13] Dethloff T., Tofteng F., Frederiksen H.-J. et al. Effect Prometheus liver assist system on systematic hemodynamics in patients with cirrhosis: a randomized controlled study // World J. Gastroenterol. — 2008. — Vol. 14, N 13. — P. 2065–2071.

[14] Di Nicuolo G., van de Kerkhove M.P., Hoekstra R. et al. No evidence of in vitro and in vivo porcine endogenous retrovirus infection after plasmapheresis through the AMC-bioartificial liver // Xenotrasplant. — 2005. — Vol. 12, N 4. — P. 286–292.

[15] Felipo V., Urios A., Montesinos E. et al. Contribution of hyperammonemia and inflammatory factors to cognitive impairment in minimal hepatic encephalopathy // Metabol. Brain Dis. — 2012. — Vol. 27. — P. 51–58.

[16] Gaspari R., Avolio A.W., Zileri Dal Verme L. et al. Molecular adsorbent recirculating system in liver transplantation: safety and efficacy // Transplant. Proc. — 2006. — Vol. 38. — P. 3544–3551.

[17] Häussinger D. Hepatic encephalopathy // Acta Gastro-Enterol. Belg. — 2010. — Vol. 73. — P. 457–464.

[18] Larsen F.S., Schmidt L.E., Wendon J. et al. Liver assisting with high-volume plasma exchange in patients with acute liver failure // Hepatol. — 2010. — Vol. 52. — P. 376А114.

[19] Méndez M., Méndez-López M., López L. et al. Portosystemic hepatic encephalopathy model show reversal learning impairment and dysfunction of neural activity in the prefrontal cortex and regions involved in motivated behavior // J. Clin. Neuroscience. — 2011. — Vol. 18, N 1. — P. 690–694.

[20] Mitzner S.R., Stange J., Klammt S. et al. Albumin dialysis MARS: knowledge from 10 years of clinical investigation // ASAIO. — 2009. — Vol. 55. — P. 498–502.

[21] Nadalin S., Heuer M., Wallot M. et al. Paediatric acute liver failure and transplantation: the University of Essen experience // Transpl. Int. — 2007. — Vol. 20. — P. 519–527.

[22] Nevens F., Laleman W. Artificial liver support devices as treatment option for liver failure // Clin. Gastroenterol. — 2012. — Vol. 26. — P. 17–26.

[23] Novelli G., Rossi M., Pretagostini M. et al. One hundred sixteen cases of acute liver failure treated with MARS // Transplant. Proc. — 2005. — Vol. 37. — P. 2557–2559.

[24] Opolon P. High-permeability membrane hemodialysis and hemofiltration in acute hepatic coma: experimental and clinical results // Artif. Organs. — 1979. — Vol. 3. — P. 354–360.

[25] Rifai K., Ernst T., Kretschmer U. et al. Prometheus — a new extracorporeal system for the treatment of liver failure // J. Hepatol. — 2003. — Vol. 39, N 6. — P. 984–990.

[26] Sen S., Davies N.A., Mookerjee R.P. et al. Parhophysiological effects of albumin dialysis in acute-on-chronic liver failure: a randomized, controlled study // Liver transplant. — 2004. — Vol. 10, N 9. — P. 1109–1119.

[27] Stefoni S., Coli L., Bolondi L. et al. Molecular adsorbent recirculating system (MARS) application in liver failure: clinical and hemodepurative result in 22 patients // Int. J. Artif. Organs. — 2006. — Vol. 29. — P. 207–218.

[28] Steiner C., Mitzner S. Experiences with MARS liver support therapy in liver failure: analysis of 176 patients of the International MARS Registry // Liver. — 2002. — Vol. 22, N 2. — P. 20–25.

[29] Tritto G., Davies N.A., Jalan R. Liver replacement therapy // Crit. Care Med. — 2012. — Vol. 33, N 1. — P. 70–79.

[30] Van de Kerkhove M.P., Di Florio E., Scuderi V. et al. Phase I clinical trial with the AMC-bioartificial liver // Int. J. Artif. Organs. — 2002. — Vol. 25, N 10. — P. 950–959.

[31] Wauters J., Wilmer A. Albumin dialysis: current practice and future options // Liver International. — 2011. — Vol. 31. — P. 9–12.

RIGHTS & PERMISSIONS

Kutepov D.E.