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Liver support mars albumin dialysis

Agnieszka Dyla, Wojciech Mielnicki, Joanna Bartczak, Tomasz Zawada, Piotr Garba
Liver failure is a serious and often deadly disease often requiring MARS (Molecular Adsorbent Recirculating System) therapy. Choosing the safe and effective method of anticoagulation during artificial liver support systems seems to be very difficult and extremely important. The aim of this study was to assess effectiveness and safety of regional anticoagulation with citrate in liver failure patients during MARS. We used a single center observational study. We analyzed 158 MARS sessions performed in 65 patients: 105 (66...
March 23, 2017: Artificial Organs
Vandana Jain, Anil Dhawan
Extracorporeal liver support systems (ELSS), encompassing artificial and bioartificial devices, have been used for decades, with the aim of supporting patients with acute liver failure and acute-on chronic liver failure, as a bridge to recovery (acute liver failure only) or liver transplantation, in an era of organ donation shortage. Although biochemical efficacy has been consistently demonstrated by these devices, translation into clinical and survival benefits has been unclear, due to study limitations and lack of reliable prognostic scoring in liver failure...
June 2017: Journal of Pediatric Gastroenterology and Nutrition
Francia C Díaz, Esteban Sáez-González, Salvador Benlloch, Diego Álvarez-Sotomayor, Isabel Conde, Begoña Polo, María García, María Rodríguez, Martín Prieto
 Background and aims. Steroid-related hepatotoxicity has become one of the most relevant causes of drug induced liver cholestasis. Some patients do not improve after standard medical treatment (SMT) and may therefore require other approaches, like extracorporeal liver support. MATERIAL AND METHODS: We report four cases of patients with pruritus, abnormal liver function tests and biopsy-proven anabolic steroid-induced cholestasis who were unresponsive to SMT. They underwent treatment with albumin dialysis (Molecular Adsorbent Recirculating System -MARS®-)...
November 2016: Annals of Hepatology
Barbara Sinner, Gabriele I Kirchner
Liver failure is a disease with a high mortality rate. Often liver transplantation is the sole therapeutic option. On the one hand, liver support systems probably support the liver to allow regeneration, on the other hand they are an option to bridge for transplantation. This article gives an overview on the clinically used liver assist devices (molecular adsorbent recirculating system [MARS], Prometheus system, single-pass albumin dialysis [SPAD], plasmapheresis) and discusses the applications in liver failure...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Euan Soo, Anja Sanders, Karlheinz Heckert, Tobias Vinke, Franz Schaefer, Claus Peter Schmitt
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...
November 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Luis Ibáñez-Samaniego, María-Vega Catalina, Diego Rincón, Oreste Lo Iacono, Ainhoa Fernández, Gerardo Clemente, Rafael Bañares, Javier Vaquero, Magdalena Salcedo
Patients with severe hepatitis C virus (HCV) recurrence after liver transplantation (LT) present an ominous prognosis, rarely achieving sustained virological response (SVR). Dialysis procedures may transiently decrease the HCV viral load, but the effect of albumin dialysis is currently unknown. Here, we evaluated the impact of albumin dialysis using the Molecular Adsorbent Recirculating System (MARS) used as a co-adjuvant antiviral treatment for severe HCV recurrence after LT. Thirteen patients (11 males, median age 48 years) with fibrosing cholestatic hepatitis or METAVIR fibrosis score ≥ F3 with severe portal hypertension underwent three consecutive MARS sessions...
April 2016: Therapeutic Apheresis and Dialysis
Christoph Sponholz, Katja Matthes, Dina Rupp, Wolf Backaus, Sebastian Klammt, Diana Karailieva, Astrid Bauschke, Utz Settmacher, Matthias Kohl, Mark G Clemens, Steffen Mitzner, Michael Bauer, Andreas Kortgen
BACKGROUND: The aim of extracorporeal albumin dialysis (ECAD) is to reduce endogenous toxins accumulating in liver failure. To date, ECAD is conducted mainly with the Molecular Adsorbents Recirculating System (MARS). However, single-pass albumin dialysis (SPAD) has been proposed as an alternative. The aim of this study was to compare the two devices with a prospective, single-centre, non-inferiority crossover study design with particular focus on reduction of bilirubin levels (primary endpoint) and influence on paraclinical and clinical parameters (secondary endpoints) associated with liver failure...
January 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
Evangelos Tsipotis, Asim Shuja, Bertrand L Jaber
Albumin dialysis is the best-studied extracorporeal nonbiologic liver support system as a bridge or destination therapy for patients with liver failure awaiting liver transplantation or recovery of liver function. We performed a systematic review to examine the efficacy and safety of 3 albumin dialysis systems (molecular adsorbent recirculating system [MARS], fractionated plasma separation, adsorption and hemodialysis [Prometheus system], and single-pass albumin dialysis) in randomized trials for supportive treatment of liver failure...
September 2015: Advances in Chronic Kidney Disease
M B Iarustovskiĭ, M V Abramian, E V Komardina, E V Rep'eva, E I Nazarova, N P Krotenko, R A Geptner
BACKGROUND & AIMS: Acute liver failure (ALF) usually develops in multiple organ dysfunction syndrome (MODS) and carries a high mortality risk in patients after cardiac surgery. Artificial liver support devices aim to remove albumin-bound and water-soluble toxins arising as a result of liver failure. The currently most used devices combine haemodialysis with albumin dialysis (MARS) or plasma separation and adsorption (Prometheus). The aim of this study was to assess safety and efficacy of use MARS or Prometheus in elderly patients with ALF have been operated for heart diseases...
September 2014: Anesteziologiia i Reanimatologiia
F Saliba, D Samuel
Since the early 1960s, several authors reported on the use of some experimental artificial liver devices in order to support patients with either acute liver failure (ALF) or end-stage chronic liver disease. In the 1980s, liver transplantation became an established real treatment replacing the whole liver with a major survival benefit. In the 1990s, the concept of albumin dialysis appeared as a new revolution in the concept of dialysis with the great capacity of removal of toxins, drugs and molecules strongly bound to albumin...
February 2015: Minerva Medica
Najla Rustom, Muriel Bost, Fleur Cour-Andlauer, Alain Lachaux, Anne-Sophie Brunet, Olivier Boillot, Fabienne Bordet, Frederic Valla, Nathalie Richard, Etienne Javouhey
OBJECTIVES: Because fulminant Wilson disease (WD) has an extremely poor prognosis, the use of liver support that can bridge patients to liver transplantation is lifesaving. We report the experience of albumin dialysis in acute liver failure (ALF) caused by WD in children. METHODS: Chart review of children admitted for ALF secondary to acute WD and treated by the molecular adsorbents and recirculating system. Measures of copper level in blood and within the circuit during molecular adsorbents recirculating system (MARS) sessions were performed...
February 2014: Journal of Pediatric Gastroenterology and Nutrition
Adrian Dominik, Jan Stange, Claudia Pfensig, Luise Borufka, Helga Weiss-Reining, Martin Eggert
The removal of small water soluble toxins and albumin-bound toxins in acute liver failure patients (ALF) or acute-on-chronic liver failure (AocLF) patients has been established using extracorporeal liver support devices (e.g. Molecular Adsorbents Recirculating System; MARS). However, reduction of elevated cytokines in ALF/AocLF using MARS is still not efficient enough to lower patients' serum cytokine levels. New membranes with larger pores or higher cut-offs should be considered in extracorporeal liver support devices based on albumin dialysis in order to address these problems, as the introduction of super-large pore membranes could counterbalance high production rates of cytokines and further improve detoxification in vivo...
August 2014: Therapeutic Apheresis and Dialysis
Faouzi Saliba, Christophe Camus, François Durand, Philippe Mathurin, Alexia Letierce, Bertrand Delafosse, Karl Barange, Pierre François Perrigault, Magali Belnard, Philippe Ichaï, Didier Samuel
BACKGROUND: Albumin dialysis with the Molecular Adsorbent Recirculating System (MARS) (Gambro, Lund, Sweden), a noncell artificial liver support device, may be beneficial in acute liver failure (ALF). OBJECTIVE: To determine whether MARS improves survival in ALF. DESIGN: Randomized, controlled trial. ( NCT00224705). SETTING: 16 French liver transplantation centers. PATIENTS: 102 patients with ALF...
October 15, 2013: Annals of Internal Medicine
Ahmed Al-Chalabi, Edouard Matevossian, Anne-K V Thaden, Peter Luppa, Albrecht Neiss, Tibor Schuster, Zejian Yang, Catherine Schreiber, Patrick Schimmel, Ewald Nairz, Aurel Perren, Peter Radermacher, Wolfgang Huber, Roland M Schmid, Bernhard Kreymann
BACKGROUND: Mortality of patients with acute liver failure (ALF) is still unacceptably high. Available liver support systems are still of limited success at improving survival. A new type of albumin dialysis, the Hepa Wash® system, was newly introduced. We evaluated the new liver support system as well as the Molecular Adsorbent Recycling System (MARS) in an ischemic porcine model of ALF. METHODS: In the first study animals were randomly allocated to control (n=5) and Hepa Wash (n=6) groups...
2013: BMC Gastroenterology
Betti Schaefer, Claus Peter Schmitt
The majority of children with acute, acute-on-chronic, and progressive chronic liver failure require liver transplantation. Since organ availability is limited, extracorporeal liver support systems are increasingly applied to bridge the time until transplantation. At present, four different devices are available: the molecular adsorbent recirculating system (MARS), Prometheus dialysis, plasma exchange combined with hemodialysis (PE/HD), and single-pass albumin dialysis (SPAD). Randomized trials in adults have demonstrated efficient toxin removal, improved portal hypertension, hemodynamic stability, and improved hepatic encephalopathy compared with standard medical therapy...
September 2013: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Guillermo Rosa-Diez, Adrián Gadano
Chronic liver diseases affect 10% of the world population. Five million people per year have acute liver failure in occidental countries. Since more than 30 years now, orthotopic liver transplantation has been the treatment of choice for selected patients with these diseases, but the lack of enough organs to satisfy the increasing need oftransplantations as well as the elevated mortality of the operation in patients in critical condition, has led to search for additional therapies. Within the last years several therapies aiming to support liver function have developed in order to serve as a bridge to liver transplantation or as replace therapy allowing regeneration of the injured live...
June 2012: Acta Gastroenterologica Latinoamericana
Frederik Nevens, Wim Laleman
Non-biological artificial liver support (ALS) devices aim to remove albumin-bound and water-soluble toxins arising as a result of liver failure. They do not directly improve the liver synthetic capacity. The currently most used devices combine haemodialysis with albumin dialysis (MARS) or plasma separation and filtration (Prometheus). These devices have been used as a treatment for different types of liver failure: acute liver failure, acute-on-chronic liver failure and primary non- or poor-function after liver transplantation...
February 2012: Best Practice & Research. Clinical Gastroenterology
Thomas A Gonwa, Hani M Wadei
Development of renal failure requiring renal replacement therapy (RRT) in the cirrhotic patient is a devastating complication. Survival without RRT is less than 10% on average at 6 months. However, it is now appreciated that all renal failure in this group of patients is not due solely to hepatorenal syndrome, and the cause of the renal failure affects the prognosis. This paper reviews the prognosis depending on cause and points out the difficulty in making the correct diagnosis. Provision of RRT is difficult in this group of patients due to hypotension and coagulopathy which is highly prevalent...
2012: Blood Purification
Ramón A Kobashi-Margáin, Juan G Gavilanes-Espinar, Ylse Gutiérrez-Grobe, Angel A Gutiérrez-Jiménez, Norberto Chávez-Tapia, Guadalupe Ponciano-Rodríguez, Misael Uribe, Nahum Méndez Sánchez
Acute, acute-on-chronic and chronic liver diseases are major health issues worldwide, and most cases end with the need for liver transplantation. Up to 90% of the patients die waiting for an organ to be transplanted. Hepatic encephalopathy is a common neuropsychiatric syndrome that usually accompanies liver failure and impacts greatly on the quality of life. The molecular adsorbent recirculating system (MARS) is a recently developed form of artificial liver support that functions on a base of albumin dialysis...
June 2011: Annals of Hepatology
Tom De Bruyn, Björn Meijers, Pieter Evenepoel, Ruth Laub, Ludo Willems, Patrick Augustijns, Pieter Annaert
Mounting evidence suggests beneficial effects of albumin dialysis-based liver support in patients suffering from acute-on-chronic liver failure. Molecular adsorbent recirculating system (MARS) is a nonbiological liver support device, based on the exchange of albumin-bound toxins between the patient's blood and a 20% human serum albumin solution in a secondary circuit. Bound toxins are continuously removed from the circulating albumin by exposure to activated charcoal and an ion-exchange resin. The aim of the present in vitro study was to determine the impact of exposure to charcoal and resin on the ligand binding properties of albumins, containing various levels of stabilizers and obtained from different suppliers (Baxter, CAF-DCF [Red Cross], and Sigma-Aldrich)...
January 2012: Artificial Organs
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