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Chen YS, Wu ZW, He JQ, Yu J, Yang SG, Zhang YM, Du WB, Cao HC, Li LJ. The Curative Effect of ALSS on 1-month Mortality in AoCLF Patients after 72 to 120 Hours. Int J Artif Organs 2018; 30:906-14. [PMID: 17992652 DOI: 10.1177/039139880703001008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Hepatitis B virus (HBV)-related acute-on-chronic liver failure (AoCLF) is associated with a high mortality rate. An artificial liver support system (ALSS) creates a better environment for the self-regeneration of retained hepatocytes. Aim and Patients We investigated the curative effect of ALSS on 1-month mortality at 72–120 h post-ALSS in 289 AoCLF patients. Methods Of the 289 patients, 117 who survived for at least 1 month post-ALSS comprised the survival group; the remaining cases who died within 1 month served as controls. The improvements in laboratory data and clinical syndromes at 72–120 h post-ALSS were compared with those at 24 h. Results Total bilirubin, international normalized ratio, and creatinine levels, and encephalopathy were significantly improved at 24 h post-ALSS in both the groups (p<0.05); however, these variables showed deterioration at 72–120 h; a rebound occurred in the nonsurvivors (p>0.05). The improvements in these variables in the nonsurvivors were considerably smaller than those in the survivors (p<0.05), particularly at 72–120 h. One-month mortality was more accurately predicted by the logistic regression model at 72–120 h than at 24 h. Conclusions The prognosis of AoCLF patients was highly dependent on the improvement in encephalopathy, total bilirubin, international normalized ratio, and creatinine levels at 72–120 h post-ALSS. These variables are useful, therefore, as disease severity indexes to determine organ allocation priorities for liver transplant.
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Affiliation(s)
- Y.-S. Chen
- State Key Laboratory of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang - China
| | - Z.-W. Wu
- State Key Laboratory of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang - China
| | - J.-Q. He
- State Key Laboratory of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang - China
| | - J. Yu
- State Key Laboratory of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang - China
| | - S.-G. Yang
- State Key Laboratory of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang - China
| | - Y.-M. Zhang
- State Key Laboratory of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang - China
| | - W.-B. Du
- State Key Laboratory of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang - China
| | - H.-C. Cao
- State Key Laboratory of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang - China
| | - L.-J. Li
- State Key Laboratory of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang - China
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Akdogan M, Camci C, Gurakar A, Gilcher R, Alamian S, Wright H, Nour B, Sebastian A. The effect of total plasma exchange on fulminant hepatic failure. J Clin Apher 2006; 21:96-9. [PMID: 16142721 DOI: 10.1002/jca.20064] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Total plasma exchange (TPE) corrects coagulopathy in patients with liver disease and removes hepatotoxins/cytokines. This improvement is transient but can be used as a bridge until an organ is identified for liver transplantation (LTx) or the liver itself regenerates. Our aim was to retrospectively assess the efficacy of TPE in fulminant hepatic failure (FHF) and its impact on liver function tests. Between 1995-2001, 39 patients with FHF who had undergone TPE were reviewed. FHF was defined according to the O'Grady criteria based on the duration of encephalopathy as well as jaundice. TPE was performed using the Cobe Spectra TPE (Gambro) in Liver Intensive Care Unit, continued on a daily basis, until either adequate clinical response was achieved, the patient expired, or transplantation occurred. INR, PTT, Fibrinogen, ALT, AST, GGT, BUN, Ammonia, and Total Bilirubin were analyzed before and after TPE. Student's t-test and chi-square test and ANOVA were used for statistical analysis. Thirty-nine patients with FHF (31 females, 8 males with mean age of 32.3, range: 7-64) underwent TPE. Coagulopathy, hyperbilirubinemia, hyperammonemia were significantly improved (P < 0.05). Twenty-one patients survived (54%), 12 required LTx, and 18 patients (including one after LTx) expired. TPE was found to be significantly effective for correction of coagulopathy and improvement of liver tests. This intervention can be considered for temporary liver support until recovery or liver transplantation.
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Affiliation(s)
- M Akdogan
- Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73120, USA
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Du WB, Li LJ, Huang JR, Yang Q, Liu XL, Li J, Chen YM, Cao HC, Xu W, Fu SZ, Chen YG. Effects of artificial liver support system on patients with acute or chronic liver failure. Transplant Proc 2006; 37:4359-64. [PMID: 16387120 DOI: 10.1016/j.transproceed.2005.11.044] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS Acute on chronic liver failure (AoCLF) is associated with a high mortality rate. Artificial liver support system (ALSS) is useful to bridge patients with liver failure to liver transplantation or to regenerate their own livers. The aims of this prospective study were to investigate the effects of ALSS on clinical manifestations, liver function, and 30-day survival to probe the factors related to mortality in patients with AoCLF. METHODS In this study, 338 enrolled patients with AoCLF who received ALSS treatment for 1 to 8 sessions, were compared with 312 patients treated with conventional medications. RESULTS Clinical manifestations and liver functions were significantly improved, namely, decreased levels of serum transaminases, total bilirubin, and bile acid, as well as increased levels of serum albumin following ALSS treatment. The 30-day survival rates of the patients who received ALSS versus controls were 47.9% versus 34.6%, respectively (P = .01). The MELD score and the stage of hepatic encephalopathy were highly associated with mortality (P < .001), but the sessions of ALSS showed a positive relation to the 30-day survival (P < .05). CONCLUSIONS ALSS appears to be efficacious and safe for the treatment of patients with AoCLF. Both model for end-stage liver disease (MELD) score and hepatic encephalopathy are useful to predict the mortality of patients.
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Affiliation(s)
- W B Du
- Key Laboratory of Infectious Diseases, Ministry of Public Health of China, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Abstract
Since its clinical availability approximately 25 years ago, therapeutic plasma exchange (TPE) has become recognized as appropriate primary therapy for many diverse medical conditions. In some aspects TPE has been constrained in its use according to schedules of efficacy. Expansion of TPE to other indications is likely once attention is focused on its ability to enable patients to avoid potentially toxic pharmacologic interventions if employed as a chronic therapy, and especially when it is accepted that adjunctive use, not only a curative role, is a valuable use of this therapeutic modality.
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Affiliation(s)
- Samuel H Pepkowitz
- Department of Pathology and Laboratory Medicine, Rita and Taft Schreiber Division of Transfusion Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Visco G, Giannuzzi R, Paglia MG, Visco Comandini U. Hemoperfusion and liver disease. BIOMATERIALS, ARTIFICIAL CELLS, AND IMMOBILIZATION BIOTECHNOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ARTIFICIAL CELLS AND IMMOBILIZATION BIOTECHNOLOGY 1993; 21:265-81. [PMID: 8318618 DOI: 10.3109/10731199309117363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
After first adventurous attempts to apply perfusion techniques to the treatment of liver diseases, more extensive experiences have been acquired in the last twenty years, not only in acute hepatic failure but also in some chronic liver diseases (mainly in CAH:chronic active hepatitis, and in primary biliary cirrhosis) and in a severe complication of them, that is cryoglobulinemia. Some experiences on this field that are found in literature, using both plasma exchange and hemoperfusion, are reviewed and some personal data are reported: 15 patients with acute viral liver failure (survival rate: 33%) and 5 patients with a CAH-linked (3 viral and 2 autoimmune) cryoglobulinemia, in whom a good control of the disease parameters was obtained.
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Affiliation(s)
- G Visco
- L. Spallanzani Hospital for Infectious Diseases, Rome, Italy
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