title: Evaluation of the Hepa Wash® treatment in pigs with acute liver failure.
abstract: BACKGROUND
  Mortality of patients with acute liver failure (ALF) is still unacceptably high. Available liver support systems are still of limited success at improving survival. A new type of albumin dialysis, the Hepa Wash® system, was newly introduced. We evaluated the new liver support system as well as the Molecular Adsorbent Recycling System (MARS) in an ischemic porcine model of ALF.
  
  
  METHODS
  In the first study animals were randomly allocated to control (n=5) and Hepa Wash (n=6) groups. In a further pilot study, two animals were treated with the MARS-system. All animals received the same medical and surgical procedures. An intraparenchymal intracranial pressure was inserted. Hemodynamic monitoring and goal-directed fluid therapy using the PiCCO system was done. Animals underwent functional end-to-side portacaval shunt and ligation of hepatic arteries. Treatment with albumin dialysis was started after fall of cerebral perfusion pressure to 45 mmHg and continued for 8 h.
  
  
  RESULTS
  All animals in the Hepa Wash group survived the 13-hour observation period, except for one that died after stopping treatment. Four of the control animals died within this period (p=0.03). Hepa Wash significantly reduced impairment of cerebral perfusion pressure (23±2 vs. 10±3 mmHg, p=0.006) and mean arterial pressure (37±1 vs. 24±2 mmHg, p=0.006) but had no effect on intracranial pressure (14±1 vs. 15±1 mmHg, p=0.72). Hepa Wash also enhanced cardiac index (4.94±0.32 vs. 3.36±0.25 l/min/m2, p=0.006) and renal function (urine production, 1850 ± 570 vs. 420 ± 180 ml, p=0.045) and eliminated water soluble (creatinine, 1.3±0.2 vs. 3.2±0.3 mg/dl, p=0.01; ammonia 562±124 vs. 1382±92 μg/dl, p=0.006) and protein-bound toxins (nitrate/nitrite 5.54±1.57 vs. 49.82±13.27 μmol/l, p=0.01). No adverse events that could be attributed to the Hepa Wash treatment were observed.
  
  
  CONCLUSIONS
  Hepa Wash was a safe procedure and improved multiorgan system failure in pigs with ALF. The survival benefit could be the result of ameliorating different organ functions in association with the detoxification capacity of water soluble and protein-bound toxins.
authors.affiliation: II Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München 81675, Gremany. ahmed.alchalabi@gmail.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Chalabi
authors.forename: Edouard
authors.initials: E
authors.lastname: Matevossian
authors.forename: Anne-K
authors.initials: AK
authors.lastname: V Thaden
authors.forename: Peter
authors.initials: P
authors.lastname: Luppa
authors.forename: Albrecht
authors.initials: A
authors.lastname: Neiss
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.forename: Zejian
authors.initials: Z
authors.lastname: Yang
authors.forename: Catherine
authors.initials: C
authors.lastname: Schreiber
authors.forename: Patrick
authors.initials: P
authors.lastname: Schimmel
authors.forename: Ewald
authors.initials: E
authors.lastname: Nairz
authors.forename: Aurel
authors.initials: A
authors.lastname: Perren
authors.forename: Peter
authors.initials: P
authors.lastname: Radermacher
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kreymann
mesh_terms: D000641:Ammonia / Q000097:blood; D000818:Animals; D001794:Blood Pressure; D002302:Cardiac Output; D003404:Creatinine / Q000097:blood; D003956:Dialysis / Q000009:adverse effects; D004195:Disease Models, Animal; D005260:Female; D007427:Intracranial Pressure; D017114:Liver Failure, Acute / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D009566:Nitrates / Q000097:blood; D009573:Nitrites / Q000097:blood; D011897:Random Allocation; D012709:Serum Albumin / Q000378:metabolism*; D016060:Sorption Detoxification; D013552:Swine; D014556:Urine
chemical_list: D009566:Nitrates; D009573:Nitrites; D012709:Serum Albumin; D000641:Ammonia; D003404:Creatinine