Albumin dialysis reduces portal pressure acutely in patients with severe alcoholic hepatitis.
OBJECTIVE
In patients with alcoholic hepatitis (AH), inflammation contributes to the severity of portal hypertension. This study evaluates the acute effects of albumin dialysis, using the Molecular Adsorbents Recirculating System (MARS), on portal pressure in AH.


METHODS
Eleven patients with AH and portal hypertension were treated with MARS (n=8) or haemofiltration (n=3). All patients had associated organ failure manifested by hepatic encephalopathy (Grade 2 or more) or renal failure. Hepatic venous pressure gradient (HVPG) was measured before, during and after the treatment session.


RESULTS
A rapid significant reduction of HVPG was observed by 6 h (falling by > or =20% in 7/8 patients, reaching 12 mmHg in 6/8), which was sustained up to 18 h after stopping dialysis. Similar rapid sustained improvements of systemic haemodynamics were also observed. No changes occurred in three patients receiving haemofiltration alone.


CONCLUSIONS
Albumin dialysis produces clinically significant, acute reduction in portal pressure but the mechanism by which this effect is achieved is not clear. Our results suggest that MARS may be a useful adjunct in management of portal hypertension, particularly in patients with severe AH with associated organ failure.
Sen
Sambit
S
Liver Failure Group, Institute of Hepatology, University College London Medical School, 69-75 Chenies Mews, London WC1E 6HX, UK.
Mookerjee
Rajeshwar P
RP
Cheshire
Lisa M
LM
Davies
Nathan A
NA
Williams
Roger
R
Jalan
Rajiv
R
D000328:Adult; D000418:Albumins; D001794:Blood Pressure; D002319:Cardiovascular System / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000628:therapy; D006503:Hepatic Veins / Q000503:physiopathology; D006519:Hepatitis, Alcoholic / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000503:physiopathology*; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014690:Venous Pressure
D000418:Albumins