Extracorporal liver support with molecular adsorbents recirculating system in patients with hepatitis B-associated fulminant hepatic failure.
Hepatitis B virus (HBV) infection is the most prevalent cause of fulminant hepatic failure (FHF) in the Far East. HBV-associated FHF is characterised by rapidly progressive end organ dysfunction/failure and a very poor prognosis. To investigate how molecular adsorbent recirculating system (MARS) treatment impacts multiple organ system function in HBV-associated FHF. Ten consecutive patients were treated with MARS in a period of 12 months. Clinical, biochemical and haemodynamic parameters were assessed before and after MARS. Various disease severity scoring systems including model for end-stage liver disease, APACHE II, APACHE III, sequential organ failure assessment and organ system failure scores were also assessed. There were significant improvements in hepatic encephalopathy grading (p < 0.001), mean arterial pressure (p < 0.001), plasma renin activity (p = 0.027), bilirubin (p < 0.001), ammonia (p = 0.001) and creatinine levels (p < 0.001). There were also significant improvements in all the scoring systems evaluated. Meanwhile, platelet count was significantly decreased (p < 0.001). One patient was successfully bridged to liver transplantation. Three patients were alive at 3 months of follow-up. MARS can improve multiple organ functions in HBV-associated FHF. On the basis of these findings, randomised controlled studies are indicated and justified.
Tsai
M-H
MH
Division of Gastroenterology, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
Chen
Y-C
YC
Wu
C-S
CS
Ho
Y-P
YP
Fang
J-T
JT
Lien
J-M
JM
Yang
C
C
Chu
Y-Y
YY
Liu
N-J
NJ
Lin
C-H
CH
Chiu
C-T
CT
Chen
P-C
PC
D000328:Adult; D000368:Aged; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006439:Hemodynamics; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D017114:Liver Failure, Acute / Q000628:therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome