Removal of bile acids by two different extracorporeal liver support systems in acute-on-chronic liver failure.
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.
Stadlbauer
Vanessa
V
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Krisper
Peter
P
Beuers
Ulrich
U
Haditsch
Bernd
B
Schneditz
Daniel
D
Jung
Aleksandra
A
Putz-Bankuti
Csilla
C
Holzer
Herwig
H
Trauner
Michael
M
Stauber
Rudolf E
RE
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
D001647:Bile Acids and Salts; D012709:Serum Albumin; D002635:Chenodeoxycholic Acid; D019826:Cholic Acid