Zusammenfassung
Im Frühjahr 2010 wurden erneut 2 Studien präsentiert, die keine Verbesserung der Sterblichkeit der Patienten mit akut-auf-chronischem Leberversagen zeigten, obwohl sie mit einem Leberunterstützungssystem behandelt wurden. Die Autoren dieses Beitrags schlagen als Ursache für die negativen Studienergebnisse eine unzureichende Entgiftungsfunktion der Verfahren vor. Am Beispiel der Marker Ammoniak und Bilirubin wird erläutert, welche Entgiftungsziele für eine erfolgreiche Therapie anzusetzen sind. Zusätzlich werden weitere notwendige Funktionen eines Leberunterstützungssystems definiert wie Elektrolytausgleich und Kontrolle des Wasser- und Säure-Basen-Haushaltes. Auf die besondere Bedeutung der Vermeidung von Nebenwirkungen wird hingewiesen, da hierdurch die positiven Ergebnisse der Therapie zunichte gemacht werden können. Weitere offene Fragen betreffen die Auswahl der Patienten, des Therapiebeginns oder die Frage einer intermittierenden vs. einer kontinuierlichen Therapie. In diesem Kontext wird auch der derzeitige Stellenwert bioartifizieller Leberunterstützungssysteme besprochen.
Abstract
In the spring of 2010, two clinical studies that showed no improvement in the mortality of patients suffering from acute-on-chronic liver failure by treatment with liver support systems were presented. The authors of the present article suggest that the reason for the negative results is the inadequate detoxification capacity of the procedures. With the example of the surrogate markers ammonia and bilirubin, the detoxification targets for successful therapy are illustrated. In addition, other necessary functions of liver support systems, including acid–base balance, electrolyte balance, and control of water balance, are defined. The importance of avoiding side effects is particularly stressed, since the positive effects of therapy can be overshadowed. Other open questions deal with the selection of patients, the start of therapy or the issue of intermittent versus continuous therapy. In this context, the current status of bioartificial liver support systems is discussed.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Dr. Al-Chalabi ist bei der Firma Hepa Wash GmbH tätig. PD Dr. Kreymann ist der Geschäftsführer der Firma Hepa Wash GmbH. Die Firma Hepa Wash GmbH entwickelt seit 5 Jahren ein Leberunterstützungssystem.
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Al-Chalabi, A., Kreymann, B. & Huber, W. Leberunterstützungstherapien 2010. Intensivmed 47, 576–581 (2010). https://doi.org/10.1007/s00390-010-0194-1
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DOI: https://doi.org/10.1007/s00390-010-0194-1