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Molecular absorbent recirculating system for the treatment of acute liver failure in surgical patients

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

The Molecular Adsorbent Recirculating System (MARS) represents an attractive artificial liver support system for the treatment of liver insufficiency. However, neither indications for MARS treatment (i.e., after extended liver resection) nor criteria for discontinuation of therapy have been evaluated. Therefore, we analyzed the clinical data of all our surgical patients who received MARS treatment for acute liver failure (n = 7). The aim of the study was to identify prognostic indicators for survival. Four of 174 patients resected for hepatic malignancy at our institution received a total of 13 MARS treatments. Two additional patients were successfully bridged to orthotopic liver transplantation with seven MARS treatments and one patient was MARS supported after liver transplantation of a steatotic graft with three MARS treatments. Five of the seven patients survived and were dismissed an average of 31 days, ranging from 17 to 47 days, after the final MARS treatment. No technical complications or adverse effects were observed during the MARS treatments. Important prognostic factors for hepatic recovery and survival were indocyanin green plasma disappearance rates greater than 5%/min and an increase in clotting factor V levels after each MARS treatment. We conclude that MARS therapy can be an effective treatment of postoperative liver insufficiency in the surgical hepatobiliary unit.

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References

  1. Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg 2003;7:325–330.

    Article  PubMed  Google Scholar 

  2. Urata K, Hashikura Y, Ikegami T, Terada M, Kawasaki S. Standard liver volume in adults. Transplant Proc 2000;32:2093–2094.

    Article  PubMed  CAS  Google Scholar 

  3. Heinemann A, Wischhusen F, Puschel K, Rogiers X. Standard liver volume in the Caucasian population. Liver Transpl Surg 1999;5:366–368.

    Article  PubMed  CAS  Google Scholar 

  4. Kiuchi T, Tanaka K. How much liver does the patient need? In: Rogiers X, Bismuth H, Busuttil RW, Broering DC, Azoulay D, eds. Split Liver Transplantation. Darmstadt: Springer, 2002, pp 105–114.

    Google Scholar 

  5. Schindl MJ, Redhead DN, Fearon KC, Garden OJ, Wigmore SJ. The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 2005;54:289–296.

    Article  PubMed  CAS  Google Scholar 

  6. Yigitler C, Farges O, Kianmanesh R, Regimbeau JM, Abdalla EK, Belghiti J. The small remnant liver after major liver resection: how common and how relevant? Liver Transpl 2003;9:S18-S25.

    Article  PubMed  Google Scholar 

  7. Stange J, Mitzner SR, Risler T, et al. Molecular Adsorbent Recycling System (MARS): clinical results of a new membrane-based blood purification system for bioartificial liver support. Artif Organs 1999;23:319- 330.

    Article  PubMed  CAS  Google Scholar 

  8. Mitzner SR, Stange J, Klammt S, Peszynski P, Schmidt R, Noldge-Schomburg G. Extracorporeal detoxification using the Molecular Adsorbent Recirculating System for critically ill patients with liver failure. J Am Soc Nephrol 2001; 12(suppl:17):S75-S82.

    PubMed  CAS  Google Scholar 

  9. Sen S, Williams R, Jalan R. Emerging indications for albumin dialysis. Am J Gastroenterol 2005;100:468–475.

    Article  PubMed  Google Scholar 

  10. Heemann U, Treichel U, Loock J, et al. Albumin dialysis in cirrhosis with superimposed acute liver injury: a prospective, controlled study. Hepatology 2002;36:949–958.

    PubMed  CAS  Google Scholar 

  11. Stange J, Hassanein TI, Mehta R, Mitzner SR, Bartlett RH. The molecular adsorbents recycling system as a liver support system based on albumin dialysis: a summary of preclinical investigations, prospective, randomized, controlled clinical trial, and clinical experience from 19 centers. Artif Organs 2002;26:103–110.

    Article  PubMed  Google Scholar 

  12. van de Kerkhove MP, de Jong KP, Rijken AM, de Pont AC, van Gulik TM. MARS treatment in posthepatectomy liver failure. Liver Int 2003;23(suppl:3):44–51.

    PubMed  Google Scholar 

  13. Kellersmann R, Gassel HJ, Buhler C, Thiede A, Timmermann W. Application of Molecular Adsorbent Recirculating System in patients with severe liver failure after hepatic resection or transplantation: initial single-centre experiences. Liver 2002;22(suppl:2):56–58.

    PubMed  Google Scholar 

  14. Lamesch P, Jost U, Schreiter D, et al. Molecular Adsorbent Recirculating System in patients with liver failure. Transplant Proc 2001;33:3480–3482.

    Article  PubMed  CAS  Google Scholar 

  15. Mullhaupt B, Kullak-Ublick GA, Ambuhl P, Maggiorini M, Stocker R, Kadry Z, Clavien PA, Renner EL. First clinical experience with Molecular Adsorbent Recirculating System (MARS) in six patients with severe acute on chronic liver failure. Liver 2002;22(suppl:2):59–62.

    PubMed  CAS  Google Scholar 

  16. Novelli G, Rossi M, Pretagostini R, et al. MARS (Molecular Adsorbent Recirculating System): experience in 34 cases of acute liver failure. Liver 2002;22(suppl:2):43–47.

    PubMed  CAS  Google Scholar 

  17. Wilmer A, Nevens F, Evenepoel P, Hermans G, Fevery J. The Molecular Adsorbent Recirculating System in patients with severe liver failure: clinical results at the K.U. Leuven. Liver 2002;22(suppl:2):52–55.

    PubMed  CAS  Google Scholar 

  18. Awad SS, Swaniker F, Magee J, Punch J, Bartlett RH. Results of a phase I trial evaluating a liver support device utilizing albumin dialysis. Surgery 2001;130:354–362.

    Article  PubMed  CAS  Google Scholar 

  19. Contreras J, Poniachik J, Oksenberg D, et al. [Albumin dialysis MARS (Molecular Adsorbent Recirculating System) as a bridge for liver transplantation in acute liver failure. Report of three cases]. Rev Med Chil 2004;132:601–607.

    PubMed  Google Scholar 

  20. Ding YT, Xu QX, Qiu YD, Yang YJ. Molecular adsorbent recycling system in treating patients with acute liver failure: a bridge to liver transplantation. Hepatobiliary Pancreat Dis Int 2004;3:508–510.

    PubMed  Google Scholar 

  21. Lahdenpera A, Koivusalo AM, Vakkuri A, Hockerstedt K, Isoniemi H. Value of albumin dialysis therapy in severe liver insufficiency. Transpl Int 2005;17:717–723.

    Article  PubMed  Google Scholar 

  22. UNOS.MELDcalculator. Available at http://www.unos.org/ resources/meldpeldcalculator.asp?index=98.

  23. Gottlieb ME, Stratton HH, Newell JC, Shah DM. Indocyanine green. Its use as an early indicator of hepatic dysfunction following injury in man. Arch Surg 1984;119:264–268.

    PubMed  CAS  Google Scholar 

  24. Niemann CU, Roberts JP, Ascher NL, Yost CS. Intraoperative hemodynamics and liver function in adult-to-adult living liver donors. Liver Transpl 2002;8:1126–1132.

    Article  PubMed  Google Scholar 

  25. Jalan R, Plevris JN, Jalan AR, Finlayson ND, Hayes PC. A pilot study of indocyanine green clearance as an early predictor of graft function. Transplantation 1994;58:196–200.

    PubMed  CAS  Google Scholar 

  26. Hsieh CB, Chen CJ, Chen TW, et al. Accuracy of indocyanine green pulse spectrophotometry clearance test for liver function prediction in transplanted patients. World J Gastroenterol 2004;10:2394–2396.

    PubMed  Google Scholar 

  27. Kimura S, Yoshioka T, Shibuya M, Sakano T, Tanaka R, Matsuyama S. Indocyanine green elimination rate detects hepatocellular dysfunction early in septic shock and correlates with survival. Crit Care Med 2001;29:1159–1163.

    Article  PubMed  CAS  Google Scholar 

  28. Sakka SG, Meier-Hellmann A. Indocyanine green for the assessment of liver function in critically ill patients. Berlin, Heidelberg, New York: Springer, 2001, pp 18–26.

    Google Scholar 

  29. Elinav E, Ben-Dov I, Hai-Am E, Ackerman Z, Ofran Y. The predictive value of admission and follow up factor V and VII levels in patients with acute hepatitis and coagulopathy. J Hepatol 2005;42:82–86.

    Article  PubMed  CAS  Google Scholar 

  30. Sette H, Hughes RD, Langley PG, Gimson AE, Williams R. Heparin response and clearance in acute and chronic liver disease. Thromb Haemost 1985;54:591–594.

    PubMed  CAS  Google Scholar 

  31. de Swart CA, Nijmeyer B, Roelofs JM, Sixma JJ. Kinetics of intravenously administered heparin in normal humans. Blood 1982;60:1251–1258.

    PubMed  Google Scholar 

  32. Kjaergard LL, Liu J, Als-Nielsen B, Gluud C. Artificial and bioartificial support systems for acute and acute-onchronic liver failure: a systematic review. JAMA 2003;289:217–222.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Visceral and Transplant Surgery, University Hospital Bern, CH-3010, Bern, Switzerland

    Daniel Inderbitzin M.D., Beat Muggli M.D., Annette Ringger M.D., Guido Beldi M.D., Markus Gass M.D., Beat Gloor M.D. & Daniel Candinas M.D.

  2. Departments of Intensive Care Medicine, University Hospital Bern, Switzerland

    Bruno Regli M.D.

  3. Departments of Nephrology, University Hospital Bern, Switzerland

    Dominik Uehlinger M.D.

  4. Institute of Clinical Pharmacology, University of Bern, Bern, Switzerland

    Jürg Reichen M.D.

Authors
  1. Daniel Inderbitzin M.D.
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  2. Beat Muggli M.D.
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  3. Annette Ringger M.D.
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  4. Guido Beldi M.D.
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  5. Markus Gass M.D.
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  6. Beat Gloor M.D.
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  7. Dominik Uehlinger M.D.
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  8. Bruno Regli M.D.
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  9. Jürg Reichen M.D.
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  10. Daniel Candinas M.D.
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Correspondence to Daniel Inderbitzin M.D..

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Inderbitzin, D., Muggli, B., Ringger, A. et al. Molecular absorbent recirculating system for the treatment of acute liver failure in surgical patients. J Gastrointest Surg 9, 1155–1162 (2005). https://doi.org/10.1016/j.gassur.2005.07.026

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  • DOI: https://doi.org/10.1016/j.gassur.2005.07.026

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