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Molecular adsorbent recirculating system (Mars) in
patients with primary nonfunction and other causes of graft dysfunction
after liver transplantation in the era of extended criteria donor
organs.
Transplant Proc. 2009 Jan-Feb;41(1):253-8.
Gaspari R, Cavaliere F, Sollazzi L, Perilli V, Melchionda I, Agnes S, Gasbarrini A, Avolio AW.
Department of Anaesthesia and Intensive Care, Catholic University of Rome, Rome, Italy.
Liver
dysfunction is an important cause of morbidity and mortality after
orthotopic liver transplantation (OLT). The Molecular Adsorbent
Recirculating System (MARS) is an albumin-based dialysis system
designed to enhance the excretory function of a failing liver. MARS has
been successfully used in patients affected by advanced liver disease
and presenting with severe cholestasis. The aim of this study was to
evaluate the safety and clinical efficacy of MARS in patients with
liver dysfunction after OLT. Seven patients (primary nonfunction, 2
patients; graft dysfunction, 5 patients) fulfilled the inclusion
criteria of serum bilirubin level >15 mg/dL and least 1 of the
following clinical signs: hepatic encephalopathy (HE) > or = grade
II, hepatorenal syndrome (HRS), and intractable pruritus.
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Read more...
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Role of artificial liver support in hepatic encephalopathy.
Metab Brain Dis. 2009 Mar;24(1):15-26.
Stadlbauer V, Wright GA, Jalan R.
Institute of Hepatology, University College London Medical School, 69-75 Chenies Mews, London, WC1E 6HX, UK.
Hepatic
encephalopathy (HE) refers to the reversible neuropsychiatric disorders
observed in acute liver failure and as a complication of cirrhosis
and/or portal hypertension. This review aims to describe the
pathophysiology of HE, the rationale for the use of artificial liver
support in the treatment of HE, the different concepts of artificial
liver support and the results obtained. Ammonia has been considered
central to its pathogenesis but recently an important role for its
interaction with inflammatory responses and auto-regulation of cerebral
hemodynamics has been suggested. Artificial liver support might be able
to decrease ammonia and modulate inflammatory mediators and cerebral
hemodynamics. Bioartificial liver support systems use hepatocytes in an
extracorporeal device connected to the patient's circulation.
Artificial liver support is intended to remove protein-bound toxins and
water-soluble toxins without providing synthetic function. Both systems
improve clinical and biochemical parameters and can be applied safely
to patients. Clinical studies have shown that artificial liver support,
especially albumin dialysis, is able to improve HE in acute and
acute-on-chronic liver failure. Further studies are required to better
understand the mechanism, however, artificial liver support can be
added to the therapeutic bundle in treating HE.
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