[Therapeutic effect of the latest extracorporal elimination procedure (Prometheus treatment) in acute liver failure caused by intoxication].
BACKGROUND
Despite intensive therapy the mortality of acute liver failure without organ transplantation is 60-90%. Because of organ shortage in liver transplantation, a significant number of patients dies while being on the waiting list. In order to diminish the mortality, various trials were introduced to remove the albumin-bound and water-soluble toxins in liver failure with the aim to support the spontaneous regeneration of the liver and maintaining the patients alive until liver transplantation. Prometheus treatment is a relatively new technique combining Fractionated Plasma Separation and Adsorption (FPSA) with a high-flux dialysis. During the procedure the patient's own separated albumin-rich plasma passes through special adsorbents making possible the elimination of albumin-bound toxins, while hemodialysis gets rid of water-soluble toxins.


OBJECTIVE
The authors' intention was to demonstrate the efficiency of Prometheus treatment in acute liver failure caused by intoxication.


METHODS
Prometheus treatment was indicated in three patients who suffered from severe intoxication with paracetamol, potassium permanganate and Amanita phalloides, which resulted in a hepatic failure incurable with conservative therapy.


RESULTS
Ten treatments were performed in the three female patients. No serious complication was observed. Due to the treatment the albumin-bound (indirect bilirubin p = 0.048; bile acid p = 0.001) and water-soluble (direct bilirubin p = 0.002; creatinine p = 0.007) toxins were significantly decreased. The level of ammonia, urea nitrogen, fibrinogen and antithrombin III did not change significantly. All the three patients were cured without liver transplantation.


CONCLUSIONS
Prometheus treatment removes efficiently the accumulating toxins in acute liver failure. It is a safe elimination technique. In cases untreatable with conservative therapy it makes possible maintaining the patients alive until the liver regenerates spontaneously, or liver transplantation is feasible.
Bakos
Agnes
A
Péterfy Sándor utcai Kórház és Rendelointézet Sürgosségi Belgyógyászati és Klinikai Toxikológiai Osztály, Budapest, Alsóerdosor u. 7., 1074. bakos_v@freemail.hu
Rikker
Csaba
C
Tóvárosi
Szilveszter
S
Kárteszi
Mihály
M
D000082:Acetaminophen / Q000633:toxicity; D000328:Adult; D000545:Amanita; D005260:Female; D006382:Hemadsorption; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy*; D008115:Liver Regeneration; D019164:Liver, Artificial; D008567:Membranes, Artificial; D009145:Mushroom Poisoning / Q000150:complications; D010956:Plasmapheresis; D011196:Potassium Permanganate / Q000633:toxicity; D006435:Renal Dialysis / Q000295:instrumentation; D016060:Sorption Detoxification / Q000379:methods*
D008567:Membranes, Artificial; D011196:Potassium Permanganate; D000082:Acetaminophen