Effect of extracorporeal liver support by MARS and Prometheus on serum cytokines in acute-on-chronic liver failure.
BACKGROUND
Cytokines are believed to play an important role in acute-on-chronic liver failure (ACLF). Extracorporeal liver support systems may exert beneficial effects in ACLF via removal of cytokines. At present, two systems are commercially available, the Molecular Adsorbent Recirculating System (MARS) and Fractionated Plasma Separation, Adsorption and Dialysis (Prometheus). The aim of this study was to compare the effects of MARS and Prometheus treatments on serum cytokine levels and their clearances.


METHODS
Eight patients with ACLF underwent alternating treatments with either MARS or Prometheus in a randomized cross-over design. Thirty-four treatments (17 MARS, 17 Prometheus) were available for analysis. Serum cytokines were measured before and after each treatment, and cytokine clearance was calculated from paired arterial and venous samples and effective plasma flow one hour after the start of treatment.


RESULTS
Baseline serum levels of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-alpha (TNF-alpha), and soluble TNF-alpha receptor 1 were significantly elevated in patients with ACLF. Measurable plasma clearances were detected for all cytokines tested, but no significant changes in serum levels of any cytokine were found after treatments with MARS or Prometheus. In MARS treatments, IL-10 was cleared from plasma more efficiently than IL-6. Clearance of IL-10 was higher in Prometheus than in MARS treatments.


CONCLUSIONS
Cytokines are cleared from plasma by both MARS and Prometheus, but neither system is able to change serum cytokine levels. This discrepancy is probably due to a high rate of cytokine production in patients with ACLF.
Stadlbauer
Vanessa
V
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. vanessa.stadlbauer@meduni-graz.at
Krisper
Peter
P
Aigner
Reingard
R
Haditsch
Bernd
B
Jung
Aleksandra
A
Lackner
Carolin
C
Stauber
Rudolf E
RE
D000327:Adsorption; D000368:Aged; D018592:Cross-Over Studies; D016207:Cytokines / Q000097:blood* / Q000302:isolation & purification / Q000378:metabolism; D003956:Dialysis / Q000379:methods*; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000276:immunology* / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged
D016207:Cytokines; D008567:Membranes, Artificial