Skip to main content
SpringerLink
Log in

Comparison of two different modes of molecular adsorbent recycling systems for liver dialysis

  • Brief Report
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

In children acute liver failure is a rare but life-threatening condition from which two-thirds do not recover with supportive therapy. Treatment is limited by the availability of liver transplants. Molecular adsorbent recirculating system (MARS) dialysis is a bridge to transplantation that enhances the chances of survival during the waiting period for a transplant, although it cannot improve survival. Open albumin dialysis (OPAL) is a new mode of albumin dialysis developed to further improve dialysis efficiency.

Case diagnosis/treatment

We report a paediatric case of acute-on-chronic liver failure and compare the two modes of albumin dialysis, namely, the MARS and OPAL, used to treat this patient’s cholestatic pruritus. Removal of total and direct bilirubin, ammonia and bile acids were measured by serial blood tests. There was an increased removal of bile acids with the OPAL mode, whereas the removal of total and direct bilirubin and ammonia was similar in both modes. The patient reported better improvement in pruritus following OPAL compared to dialysis with the MARS.

Conclusion

OPAL may offer a better solution than the MARS in the treatment of refractory pruritus in liver failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cochran JB, Losek JD (2007) Acute liver failure in children. Pediatr Emerg Care 23:129–135

    Article  PubMed  Google Scholar 

  2. Stange J, Ramlow W, Mitzner S, Schmidt R, Klinkmann H (1993) Dialysis against a recycled albumin solution enables the removal of albumin-bound toxins. Artif Organs 17:809–813

    Article  CAS  PubMed  Google Scholar 

  3. Schaefer B, Schaefer F, Engelmann G, Meyburg J, Heckert KH, Zorn M, Schmitt CP (2011) Comparison of Molecular Adsorbents Recirculating System (MARS) dialysis with combined plasma exchange and haemodialysis in children with acute liver failure. Nephrol Dial Transplant 26:3633–3639

    Article  CAS  PubMed  Google Scholar 

  4. Mitzner SR, Stange J, Klammt S, Risler T, Erley CM, Bader BD, Berger ED, Lauchart W, Peszynski P, Freytag J, Hickstein H, Loock J, Lohr JM, Liebe S, Emmrich J, Korten G, Schmidt R (2000) Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial. Liver Transpl 6:277–286

    Article  CAS  PubMed  Google Scholar 

  5. Catalina MV, Barrio J, Anaya F, Salcedo M, Rincon D, Clemente G, Banares R (2003) Hepatic and systemic haemodynamic changes after MARS in patients with acute on chronic liver failure. Liver Int 23[Suppl 3]:39–43

    Article  CAS  PubMed  Google Scholar 

  6. Heemann U, Treichel U, Loock J, Philipp T, Gerken G, Malago M, Klammt S, Loehr M, Liebe S, Mitzner S, Schmidt R, Stange J (2002) Albumin dialysis in cirrhosis with superimposed acute liver injury: a prospective, controlled study. Hepatology 36:949–958

    Article  CAS  PubMed  Google Scholar 

  7. Hassanein TI, Tofteng F, Brown RS Jr, McGuire B, Lynch P, Mehta R, Larsen FS, Gornbein J, Stange J, Blei AT (2007) Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis. Hepatology 46:1853–1862

    Article  CAS  PubMed  Google Scholar 

  8. Vaid A, Chweich H, Balk EM, Jaber BL (2012) Molecular adsorbent recirculating system as artificial support therapy for liver failure: a meta-analysis. ASAIO J 58:51–59

    Article  CAS  PubMed  Google Scholar 

  9. Schaefer B, Schaefer F, Wittmer D, Engelmann G, Wenning D, Schmitt CP (2012) Molecular adsorbents recirculating system dialysis in children with cholestatic pruritus. Pediatr Nephrol 27:829–834

    Article  PubMed  Google Scholar 

  10. Pares A, Cisneros L, Salmeron JM, Caballeria L, Mas A, Torras A, Rodes J (2004) Extracorporeal albumin dialysis: a procedure for prolonged relief of intractable pruritus in patients with primary biliary cirrhosis. Am J Gastroenterol 99:1105–1110

    Article  PubMed  Google Scholar 

  11. Bellmann R, Graziadei IW, Feistritzer C, Schwaighofer H, Stellaard F, Sturm E, Wiedermann CJ, Joannidis M (2004) Treatment of refractory cholestatic pruritus after liver transplantation with albumin dialysis. Liver Transpl 10:107–114

    Article  PubMed  Google Scholar 

  12. Schaefer B, Schmitt CP (2013) The role of molecular adsorbent recirculating system dialysis for extracorporeal liver support in children. Pediatr Nephrol 28:1763–1769

    Article  PubMed  Google Scholar 

  13. Banares R, Nevens F, Larsen FS, Jalan R, Albillos A, Dollinger M, Saliba F, Sauerbruch T, Klammt S, Ockenga J, Pares A, Wendon J, Brunnler T, Kramer L, Mathurin P, de la Mata M, Gasbarrini A, Mullhaupt B, Wilmer A, Laleman W, Eefsen M, Sen S, Zipprich A, Tenorio T, Pavesi M, Schmidt HH, Mitzner S, Williams R, Arroyo V, group Rs (2013) Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial. Hepatology 57:1153–1162

    Article  CAS  PubMed  Google Scholar 

  14. Bachli EB, Schuepbach RA, Maggiorini M, Stocker R, Mullhaupt B, Renner EL (2007) Artificial liver support with the molecular adsorbent recirculating system: activation of coagulation and bleeding complications. Liver Int 27:475–484

    Article  CAS  PubMed  Google Scholar 

  15. Evenepoel P, Laleman W, Wilmer A, Claes K, Kuypers D, Bammens B, Nevens F, Vanrenterghem Y (2006) Prometheus versus molecular adsorbents recirculating system: comparison of efficiency in two different liver detoxification devices. Artif Organs 30:276–284

    Article  CAS  PubMed  Google Scholar 

Download references

Contributors’ statements

Euan Soo drafted the initial manuscript, carried out the analyses of data, presented the data and approved the final manuscript as submitted. Anja Sanders significantly contributed to the statistics, data presentation and the manuscript. Karlheinz Heckert was responsible for performing and monitoring liver dialysis episodes and coordinating the investigations for the study and approved the final manuscript as submitted. Tobias Vinke helped with data collecting and analysis and approved the final version of the manuscript. Franz Schaefer conceptualized the study, critically reviewed the manuscript and approved the final manuscript as submitted. Claus Peter Schmitt conceptualized the study, realized the study, critically reviewed the manuscript, contributed to data analysis and approved the final manuscript as submitted.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Author information

Authors and Affiliations

  1. Division of Paediatric Nephrology, Centre for Pediatric and Adolescent Medicine, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany

    Euan Soo, Karlheinz Heckert, Tobias Vinke, Franz Schaefer & Claus Peter Schmitt

  2. Paediatric Nephrology Centre, Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Kowloon, Hong Kong

    Euan Soo

  3. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

    Anja Sanders

Authors
  1. Euan Soo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anja Sanders
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karlheinz Heckert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tobias Vinke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Franz Schaefer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Claus Peter Schmitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claus Peter Schmitt.

Ethics declarations

Funding source

ES was supported by a grant from the Hospital Authority of Hong Kong.

Conflict of interest statement

The authors declare that they have no conflicts of interest regarding this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 55.4 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Soo, E., Sanders, A., Heckert, K. et al. Comparison of two different modes of molecular adsorbent recycling systems for liver dialysis. Pediatr Nephrol 31, 2171–2174 (2016). https://doi.org/10.1007/s00467-016-3451-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-016-3451-0

Keywords

Search

Navigation