Molecular adsorbent recirculating system in patients with early allograft dysfunction after liver transplantation: a pilot study.
Early allograft dysfunction (EAD) after orthotopic liver transplantation (OLT) causes marked morbidity and mortality. We conducted a prospective pilot study to assess the safety and efficacy of molecular adsorbent recirculating system (MARS) in treatment of EAD after OLT. Twelve consecutive adult liver allograft recipients with a median age of 48 years, 9 of whom were male, were prospectively included and supported with MARS. EAD was defined as the presence of at least 2 of the following: serum bilirubin >10 mg/dL, prothrombin time <40%, aspartate aminotransferase or alanine transferase >1,000 U/L, and plasma disappearance rate of indocyanine green (PDR(ICG)) <10% per minute within 72 hours after reperfusion. One-year patient and graft survival was 66%. There was a significant decrease in serum bilirubin (P = 0.002), serum creatinine (P = 0.006), and aspartate aminotransferase (P = 0.005) and a significant increase in PDR(ICG) (P = 0.007) after MARS treatment. Prothrombin time, albumin level, and platelet count remained stable. Sustained improvement of renal and neurological function and of mean arterial pressure were observed. No MARS-related adverse effects occurred. MARS treatment provides a safe approach to the treatment of EAD after OLT. On the basis of this pilot study, a multicenter randomized clinical trial that uses MARS treatment in EAD after OLT has been initiated.
Hetz
Hubert
H
Department of Anesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria. hubert.hetz@meduniwien.ac.at
Faybik
Peter
P
Berlakovich
Gabriela
G
Baker
Amir
A
Bacher
Andreas
A
Burghuber
Christopher
C
Sandner
Sigrid E
SE
Steltzer
Heinz
H
Krenn
Claus Georg
CG
D000327:Adsorption; D000328:Adult; D000818:Animals; D051799:Delayed Graft Function / Q000628:therapy*; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D007208:Indocyanine Green; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011817:Rabbits; D013950:Thymus Gland / Q000276:immunology*; D014184:Transplantation, Homologous; D019737:Transplants
D007136:Immunoglobulins; D007208:Indocyanine Green