Prometheus--a new extracorporeal system for the treatment of liver failure.
OBJECTIVE
Extracorporeal detoxification systems for supportive therapy of liver failure have recently gained much interest. We herein report results from the first clinical application of Prometheus, a new liver support system in which albumin-bound substances are directly removed from blood by special adsorber. In a simultaneous step, high-flux hemodialysis is performed. We assessed safety, adsorber efficiency and clinical efficacy of the Prometheus system.


METHODS
Eleven patients with acute-on-chronic liver failure and accompanying renal failure were treated with Prometheus on 2 consecutive days for >4 h.


RESULTS
Prometheus treatment significantly improved serum levels of conjugated bilirubin, bile acids, ammonia, cholinesterase, creatinine, urea and blood pH. There were no significant changes in hemoglobin and platelet levels, whereas leucocytes increased without signs of systemic infection. No treatment-related complications except a blood pressure drop in two patients with systemic infection were noted. In one patient (Child-Pugh score: 15) Prometheus treatment could not be completed due to onset of uncontrolled bleeding 16 h after dialysis.


CONCLUSIONS
Prometheus is a safe supportive therapy for patients with liver failure. A significant improvement of the biochemical milieu was observed already after two treatments. Prospective controlled studies with the Prometheus system are necessary to evaluate hard clinical end-points.
Rifai
Kinan
K
Division of Gastroenterology, Hepatology and Endocrinology, Department of Internal Medicine, Medical School Hannover, Carl Neuberg Strasse 1, 30625 Hannover, Germany. rifai.k@gmx.de
Ernst
Thomas
T
Kretschmer
Ulrich
U
Bahr
Matthias J
MJ
Schneider
Andrea
A
Hafer
Carsten
C
Haller
Hermann
H
Manns
Michael P
MP
Fliser
Danilo
D
D000328:Adult; D001663:Bilirubin / Q000097:blood; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D005260:Female; D006501:Hepatic Encephalopathy / Q000401:mortality / Q000628:therapy; D006530:Hepatorenal Syndrome / Q000401:mortality / Q000628:therapy; D006801:Humans; D017114:Liver Failure, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016060:Sorption Detoxification / Q000295:instrumentation*; D016896:Treatment Outcome
D001663:Bilirubin