title: Removal of bile acids by two different extracorporeal liver support systems in acute-on-chronic liver failure.
abstract: Acute-on-chronic liver failure (ACLF) is accompanied by marked intrahepatic cholestasis leading to accumulation of cytotoxic bile acids. Extracorporeal liver support systems efficiently remove bile acids, but their effect on bile acid composition in ACLF is unknown. The aim of the present study was to compare elimination of individual plasma bile acids by albumin dialysis (Molecular Adsorbents Recirculating System, MARS) and fractionated plasma separation (Prometheus). Eight consecutive patients with ACLF underwent alternating 6-hour sessions with MARS or Prometheus in a randomized, cross-over design. Serum samples were obtained before, during, and after each treatment, and individual bile acids including cholic acid and chenodeoxycholic acid (CDCA) were measured by gas chromatography. MARS and Prometheus removed total bile acids to a similar extent (reduction ratio, 45% and 46%, respectively). Both devices cleared cholic acid more efficiently than did CDCA. The molar fraction of CDCA (fCDCA) was elevated at baseline and correlated with the degree of liver dysfunction. Prometheus but not MARS treatments further increased fCDCA. Although both devices eliminate total bile acids to a similar extent, clearance of individual bile acids is different, leading to a slight change of the bile acid profile toward hydrophobic bile acids during Prometheus treatments.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Stadlbauer
authors.forename: Peter
authors.initials: P
authors.lastname: Krisper
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beuers
authors.forename: Bernd
authors.initials: B
authors.lastname: Haditsch
authors.forename: Daniel
authors.initials: D
authors.lastname: Schneditz
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Jung
authors.forename: Csilla
authors.initials: C
authors.lastname: Putz-Bankuti
authors.forename: Herwig
authors.initials: H
authors.lastname: Holzer
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
authors.forename: Rudolf E
authors.initials: RE
authors.lastname: Stauber
mesh_terms: D000368:Aged; D001647:Bile Acids and Salts / Q000097:blood*; D002635:Chenodeoxycholic Acid / Q000097:blood; D019826:Cholic Acid / Q000097:blood; D018592:Cross-Over Studies; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012709:Serum Albumin / Q000032:analysis; D016060:Sorption Detoxification / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001647:Bile Acids and Salts; D012709:Serum Albumin; D002635:Chenodeoxycholic Acid; D019826:Cholic Acid