Results of treatment of acute liver failure patients with use of the prometheus FPSA system.
OBJECTIVE
Herein we have presented the results of treatment of acute liver failure (ALF) patients with the use of the Prometheus FPSA dialysis system.


METHODS
To January 2009, we performed 278 FPSA procedures in 114 patients, including 52 experience and ALF. The patients who underwent the FPSA procedure consisted of 32 women and 20 men of overall mean age of 33 +/- 12 years. The causes of ALF were: Wilson's disease (n = 15), unknown origin ALF (n = 11), amanita phalloides intoxication (n = 7), paracetamol intoxication (n = 8), acute hepatitis B virus (HBV)/hepatitis C virus (HCV) infection (n = 7), liver insufficiency after parenchymal resection (n = 2) drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome (n = 1), rabdomyolysis (n = 1), or primary nonfunction (PNF) after orthotopic liver transplantation (OLT) (n = 1). All procedures were performed using the Prometheus 4008H Fresenius Medical Care liver support system. The average number of treatments per patient was 2.41 and the average time for each FPSA treatment was 6.3 hours. The average heparin dose used during the procedure was 750 IU/h.


RESULTS
After the whole treatment regimen, we observed significant improvements in the biochemical results. The average concentrations improved: serum ammonia (before 249.2 mug/dL versus after 109.7 mug/dL); serum bilirubin (before 21.53 mg/dL versus after 8.81 mg/dL), serum aspartate aminotransferase (AST; before 2456.4 U/L versus after 1068.8 U/L); serum alanine aminotransferase (ALT; before 2958.2 U/L versus after 1595.8 U/L); serum urea (before 58.5 mg/dL versus after 21.1 mg/dL); serum creatinine (before 2.9 mg/dL versus after 1.7 mg/dL); and pH value (before 7.11 versus after 7.32). After Prometheus treatment OLT was performed in 33 patients. Among the 28 who survived (53.8%), 22 underwent OLT and 6 did not have OLT. Among the 24 patients who died (46.2%), 13 were before OLT and 11 after OLT.


CONCLUSIONS
The Prometheus 4008H Fresenius Medical Care Liver support system was useful method of detoxification for patients with ALF, serving as an element of pretransplantation care.
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, UI. Banacha 1A, 02-097 Warsaw, Poland.
M
M
Grodzicki
M
M
Kotulski
D
D
Leonowicz
K
K
Zieniewicz
M
M
Krawczyk
D000328:Adult; D003956:Dialysis / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006527:Hepatolenticular Degeneration / Q000150:complications; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000150:complications; D017114:Liver Failure, Acute / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D055815:Young Adult