20 May 2003 : Original article
Med Sci Monit 2003; 9(2): 77-81 :: ID: 15327
Hepatic encephalopathy (HE)may occur in patients with acute and decompensated chronic liver failure.One of the pathogenetic mechanisms is accumulation of ‘liver ’toxins such as ammonia in astrocytes causing brain oedema.In cases of acute liver failure deterioration of patient ’s condition to coma may be rapid and outcome poor.Multiple attempts have been made to reduce mortality of patients with HE.Urgent liver transplantation is considered as treatment of choice in most patients.Many therapies have been used to remove ‘liver ’toxins from circulation:dialysis, hemoperfusion, plasmapheresis, extracorporeal liver perfusion and others.None of them remained in routine clinical practice.Recently a new cell-free method designed for the selective removal of albumin-bound substances normally cleared by the liver (MARS –Molecular Adsorbent Recirculating System) is available. We have been using this method in Children ’s Memorial Health Institute since July 2001 to support vital functions in some patients listed for liver transplantation.Till now we have performed 11 sessions in 7 patients with acute liver failure and hepatic encephalopathy.Four patients survived (one recovered without liver transplantation and three were transplanted) and three patients died (two before organ for transplantation was available and one during surgical procedure).We have obtained decrease of serum toxins concentration (ammonia, bilirubine, creatinine and others) and clinical improvement. In our opinion albumin dialysis MARS is promising new method of detoxification in critically ill patients with liver dysfunction.
Keywords: hepatic encephalopathy, albumin dialysis, Mars
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