Comparison of the molecular adsorbent recirculating system and plasmapheresis for patients with graft dysfunction after liver transplantation.
BACKGROUND
Graft dysfunction after liver transplantation (OLT) is a life- threatening condition. Molecular adsorbent recirculating system (MARS) or plasmapheresis (PLP) may be effective supportive therapy of graft dysfunction for patients who cannot undergo retransplantation. The aim of this study was to compare the effects of MARS and PLP in patients with graft dysfunction after OLT.


METHODS
Between January 2002 and July 2007, 31 OLT recipients who experienced graft dysfunction, defined as hyperbilirubinemia (>10 mg/dL) without bile duct obstruction and/or presence of hepatic encephalopathy, were treated with MARS or PLP. Biochemical and hemodynamic data and survival were compared in MARS and PLP groups.


RESULTS
Fifteen patients were treated with 41 MARS sessions and 16 with 105 PLP sessions. After a single MARS session, patients showed significant reductions in creatinine, urea nitrogen, bilirubin, and ammonia. After a single PLP session, patients showed significant improvements in prothrombin time, bilirubin, alanine aminotransferase, alkaline phosphatase, and albumin. After the completion of treatment, Both MARS and PLP significantly improved bilirubin values. at 90 days there were no differences in overall survival rates; 53% in MARS versus 56% in PLP.


CONCLUSIONS
Both MARS and PLP are alternative supportive treatments for graft dysfunction after OLT.
Lee
J Y
JY
Department of Internal Medicine, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
Kim
S B
SB
Chang
J W
JW
Park
S-K
SK
Kwon
S-W
SW
Song
K W
KW
Hwang
S
S
Lee
S G
SG
D000328:Adult; D001663:Bilirubin / Q000097:blood; D001783:Blood Flow Velocity; D001806:Blood Urea Nitrogen; D002102:Cadaver; D003404:Creatinine / Q000097:blood; D005260:Female; D015600:Glasgow Coma Scale; D006084:Graft Rejection / Q000628:therapy; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010956:Plasmapheresis / Q000379:methods*; D055031:Primary Graft Dysfunction / Q000628:therapy*; D012189:Retrospective Studies; D016060:Sorption Detoxification / Q000379:methods*; D014019:Tissue Donors / Q000706:statistics & numerical data
D003404:Creatinine; D001663:Bilirubin