title: Noncardiogenic pulmonary edema induced by a molecular adsorbent recirculating system: case report.
abstract: Noncardiogenic pulmonary edema is a well-recognized manifestation of acute lung injury which has been related, among others, to blood or blood-product transfusion, intravenous contrast injection, air embolism, and drug ingestion. We describe two cases of noncardiogenic pulmonary edema after use of a molecular adsorbent recirculating system, a cell-free dialysis technique. Patients in this series presented at our institution to be evaluated for liver transplantation. Subsequently, they developed an indication for the molecular adsorbent recirculating system. Two patients of 30 (6.6%) treated with the molecular adsorbent recirculating system for acute-on-chronic liver failure and intractable pruritus had normal chest X-rays before treatment and developed severe pulmonary edema, in the absence of cardiogenic causes, following use of the molecular adsorbent recirculating system. For each patient we reviewed the history of blood or blood-product transfusion, echocardiograms if available, daily chest X-rays, and when available pre- and postmolecular adsorbent recirculating systemic blood pressure, central venous pressure, pulmonary arterial pressures, cardiac output, cardiac index, systemic vascular resistance index, and arterial blood gas. Our data suggest that the molecular adsorbent recirculating system may cause noncardiogenic pulmonary edema, possibly by an immune-mediated mechanism.
authors.affiliation: Liver Transplantation and Liver Surgery, Transplantation Division, Department of Surgery, Thomas Jefferson University, 1025 Walnut Street, Suite 605 College Building, Philadelphia, PA 19107, USA. cataldo.doria@mail.tju.edu
authors.forename: Cataldo
authors.initials: C
authors.lastname: Doria
authors.forename: Lucio
authors.initials: L
authors.lastname: MandalA
authors.forename: Victor L
authors.initials: VL
authors.lastname: Scott
authors.forename: Ignazio R
authors.initials: IR
authors.lastname: Marino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: Roberto
authors.initials: R
authors.lastname: Miraglia
authors.forename: Claudio H
authors.initials: CH
authors.lastname: Vitale
authors.forename: Jan
authors.initials: J
authors.lastname: Smith
mesh_terms: D000368:Aged; D018450:Disease Progression; D017809:Fatal Outcome; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000628:therapy*; D019164:Liver, Artificial / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D013902:Radiography, Thoracic; D018570:Risk Assessment; D012720:Severity of Illness Index