ABSTRACT

Extracorporeal liver support systems represent an important option for the treatment of liver failure. In this retrospective study, effects of two different support systems were examined, and these systems were compared.

Molecular Absorbent Recirculating System (MARS) (10 patients) and fractionated plasma separation and adsorption (FPSA) (28 patients) were performed 114 times in 38 patients. The frequencies of liver transplantation and survival; SOFA and hepatic encephalopathy scores, levels of total bilirubin, ammonia, albumin, blood urea nitrogen (BUN), creatinine and lactate, leucocyte and thrombocyte counts, as well as frequency of hemodynamic instability were investigated and compared. The method used for anticoagulation, the number of applications/patients and the length of stay in ICU were also recorded.

There were 3±1.8 (range: 1-7) treatments/patient. All transplanted patients (n=7; MARS: 3, FPSA: 4) and 12 (30.8%) of the remaining patients without transplantation survived, obtaining an overall survival of 50%. There was a decrease in the levels of bilirubin, BUN and creatinine with both systems; the decrease was more pronounced with FPSA. FPSA also achieved a significant decrease in ammonia level. With FPSA, there were also significant changes in albumin, leucocyte and thrombocyte counts and INR. MARS was associated with significantly less hemodynamic instability.

Both systems have been found to be effective as a “bridge therapy” for liver transplantation, in 1/4 of the patients they can even eliminate the indication for liver transplantation. Effects of FPSA on detoxification appeared to be more pronounced, whereas MARS obtained a more stable hemodynamic status during treatment.

Keywords: Liver failure, dialysis, adsorption