Acute systemic, splanchnic and renal haemodynamic changes induced by molecular adsorbent recirculating system (MARS) treatment in patients with end-stage cirrhosis.
OBJECTIVE
To evaluate the acute effect of treatment with the molecular adsorbent recirculating system (MARS) on splanchnic, renal and systemic haemodynamics in patients with end-stage cirrhosis.


METHODS
Twelve patients with end-stage cirrhosis, undergoing MARS treatment, were enrolled. The following haemodynamic parameters were measured by means of Doppler ultrasonography and thoracic electrical bioimpedance, before and after each session: portal velocity, renal and splenic resistance indices, cardiac output, cardiac stroke volume, heart rate, mean arterial pressure, systemic vascular resistance.


RESULTS
Median portal velocity increased significantly after treatment (23.7 vs. 20.3 cm/s, P < 0.05) while renal resistance index (0.72 vs. 0.75, P < 0.05) and splenic resistance index (0.60 vs. 0.65, P < 0.05) decreased significantly. Mean arterial pressure (83 vs. 81 mmHg, P < 0.05) and vascular resistance (899 vs. 749 dyne. s/cm5, P < 0.05) increased significantly, while cardiac output and stroke volume showed no significant changes.


CONCLUSIONS
Data emerging from this investigation suggest that MARS treatment improves significantly various haemodynamic alterations in cirrhotic patients in the short term. The observed decrease in renal vascular resistance and improvement in splenic resistance index, a parameter related to portal resistance, which leads us to hypothesize that these haemodynamic effects are probably mediated by clearance of vasoactive substances during MARS treatment.
Donati
G
G
Division of Internal Medicine, Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy.
Piscaglia
F
F
Colì
L
L
Silvagni
E
E
Righini
R
R
Donati
G
G
Pini
P
P
Stefoni
S
S
Bolondi
L
L
D000328:Adult; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D017093:Liver Failure / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012079:Renal Circulation / Q000502:physiology*; D016060:Sorption Detoxification / Q000379:methods*; D013152:Splanchnic Circulation / Q000502:physiology*; D016896:Treatment Outcome; D014463:Ultrasonography; D014655:Vascular Resistance / Q000502:physiology