title: The use Prometheus FPSA system in the treatment of acute liver failure: preliminary results.
abstract: The preliminary outcomes of patients with acute liver failure treated with the Prometheus Fractionated Plasma Separation and Absorption (FPSA) system are presented herein.
  
  
  METHODS
  The procedures were performed in 13 patients (4, intoxication by Amanita phalloides; 4, unknown reason; 3, acetaminophen intoxication; 1, Wilson disease, and 1, liver insufficiency after hemihepatectomy owing to metastases of colon adenocarcinoma). The patients were qualified for the procedure according to the King's College Hospital criteria. The patients' general status was assessed on basic of GCS, UNOS, and the 4-grade encephalopathy classifications. The procedures were performed with the Prometheus 4008H Fresenius Medical Care unit.
  
  
  RESULTS
  The 29 procedures were of mean duration 6.5 hours. There were statistically significant reductions in total bilirubin, ammonia, and aminotransferase levels. In addition, the procedures corrected water, mineral, and carbohydrate disorders. One patient did not require liver transplantation. Seven patients received liver transplants: three patients with positive outcomes; two died due to septicemia within 30 days perioperatively, one died at 6 months after OLT owing to respiratory failure; and one, owing to hemorrhagic diathesis. Four patients did not receive a liver transplant because of lack of a organ, no consent for the surgery, or neoplastic disease with metastases.
  
  
  CONCLUSIONS
  The Prometheus FPSA-System was an effective detoxication method for patients with acute liver failure. The system was useful as a symptomatic treatment before liver transplantation allowing a longer wait for a graft.
authors.affiliation: Department of General, Transplant and Liver Surgery, Warsaw Medical University, ul. Banacha 1a, 02-097 Warsaw, Poland. skwareka@tlen.pl
authors.forename: A
authors.initials: A
authors.lastname: Skwarek
authors.forename: M
authors.initials: M
authors.lastname: Grodzicki
authors.forename: P
authors.initials: P
authors.lastname: Nyckowski
authors.forename: M
authors.initials: M
authors.lastname: Kotulski
authors.forename: K
authors.initials: K
authors.lastname: Zieniewicz
authors.forename: B
authors.initials: B
authors.lastname: Michalowicz
authors.forename: W
authors.initials: W
authors.lastname: Patkowski
authors.forename: I
authors.initials: I
authors.lastname: Grzelak
authors.forename: A
authors.initials: A
authors.lastname: Paczkowska
authors.forename: D
authors.initials: D
authors.lastname: Giercuszkiewicz
authors.forename: J
authors.initials: J
authors.lastname: Sańko-Resmer
authors.forename: L
authors.initials: L
authors.lastname: Paczek
authors.forename: M
authors.initials: M
authors.lastname: Krawczyk
mesh_terms: D015415:Biomarkers / Q000097:blood; D004867:Equipment Design; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000502:physiology*; D019164:Liver, Artificial; D016060:Sorption Detoxification; D016019:Survival Analysis; D013610:Tachycardia / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers