title: [Extracorporeal methods of hematological correction in patients with acute liver insufficiency after cardiac surgery].
abstract: OBJECTIVE
  Acute liver failure (ALF) usually develops in multiple organ dysfunction syndrome (MODS) and carries a high mortality risk in patients after cardiac surgery. Artificial liver support devices aim to remove albumin-bound and water-soluble toxins arising as a result of liver failure. The currently most used devices combine haemodialysis with albumin dialysis (MARS) or plasma separation and adsorption (Prometheus). The aim of this study was to assess safety and efficacy of use MARS or Prometheus in elderly patients with ALF have been operated for heart diseases.
  
  
  METHODS
  We studied 26 elder patients with ALF and MODS as postoperative complication after cardiac surgery. Patients were assigned to groups, given a combination of MARS and standard medical therapy (SMT) (MARS-group, n=9) or Prometheus and SMT (Prometheus-group, n=17). Inclusion criteria were clinical and laboratory signs of ALF: serum total bilirubin level>180 mkmol/L, 2-fold increasing serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), low serum cholinesterase and high serum ammonia levels. A variety of clinical and biochemical parameters were assessed. Primary endpoint was survival probabilities at day 28.
  
  
  RESULTS
  MARS was used to provide 1 to 2 rounds (minimum of 6 hours each) and Prometheus was used to provide 2 to 14 rounds (minimum of 6 hours each). There were amelioration of haemodinamic instability, especially in MARS-group (increase in ADmean was 17% in MARS (p=0.005) and 10% in Prometheus-group (p=0.001)), increase in P/F ratio (12% in Prometheus-group (p=0.07)), decrease in serum total bilirubin (8.6% in MARS-group (p=0.028) and 33% in Prometheus-group (p<0.001)) and unconjugated bilirubin levels (29% in Prometheus-group (p=0.003)), also we had decreasing in serum aminotransferase levels and trend to increasing in serum cholinesterase level (12% in MARS-group (p=0.87) and 8% in Prometheus-group (p=0.86)). There were no side effects of extracorporeal liver support in both patients groups. Survival of patients with ALF, treated with MARS was 22%, in Prometheus group--35%.
  
  
  CONCLUSIONS
  MARS and Prometheus are found to be safe and effective in patients with ALF after cardiac surgery. Further studies are needed to assess whether therapy might be beneficial in specific sublets of patients.
authors.forename: M B
authors.initials: MB
authors.lastname: Iarustovskiĭ
authors.forename: M V
authors.initials: MV
authors.lastname: Abramian
authors.forename: E V
authors.initials: EV
authors.lastname: Komardina
authors.forename: E V
authors.initials: EV
authors.lastname: Rep'eva
authors.forename: E I
authors.initials: EI
authors.lastname: Nazarova
authors.forename: N P
authors.initials: NP
authors.lastname: Krotenko
authors.forename: R A
authors.initials: RA
authors.lastname: Geptner
mesh_terms: D000208:Acute Disease; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D005260:Female; D048550:Hepatic Insufficiency / Q000097:blood / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology / Q000628:therapy*; D010951:Plasma Exchange / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome