Effect of Prometheus liver assist system on systemic hemodynamics in patients with cirrhosis: a randomized controlled study.
OBJECTIVE
To evaluate treatment safety and hemodynamic changes during a single 6-h treatment with the Prometheus liver assist system in a randomized, controlled study.


METHODS
Twenty-four patients were randomized to either the study group or to one of two control groups: Fractionated Plasma Separation Adsorption and Dialysis, Prometheus system (Study group; n = 8); Molecular Adsorbent Recirculation System (MARS) (Control group 1, n = 8); or hemodialysis (Control group 2; n = 8). All patients included in the study had decompensated cirrhosis at the time of the inclusion into the study. Circulatory changes were monitored with a Swan-Ganz catheter and bilirubin and creatinine were monitored as measures of protein-bound and water-soluble toxins.


RESULTS
Systemic hemodynamics did not differ between treatment and control groups apart from an increase in arterial pressure in the MARS group (P = 0.008). No adverse effects were observed in any of the groups. Creatinine levels significantly decreased in the MARS group (P = 0.03) and hemodialysis group (P = 0.04). Platelet count deceased in the Prometheus group (P = 0.04).


CONCLUSIONS
Extra-corporal liver support with Prometheus is proven to be safe in patients with endstage liver disease but does not exert the beneficial effects on arterial pressure as seen in the MARS group.
Dethloff
Thomas
T
Department of Hepatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Tofteng
Flemming
F
Frederiksen
Hans-Jorgen
HJ
Hojskov
Michael
M
Hansen
Bent-Adel
BA
Larsen
Fin-Stolze
FS
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology; D001663:Bilirubin / Q000378:metabolism; D001794:Blood Pressure; D003404:Creatinine / Q000737:chemistry; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000628:therapy*; D017093:Liver Failure / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D016060:Sorption Detoxification / Q000379:methods; D016896:Treatment Outcome
D000925:Anticoagulants; D003404:Creatinine; D001663:Bilirubin