ObjectiveTo summerize the experiences of using molecular adsorbent recycling system(MARS) in perioperative period of orthotopic liver transplantation (OLT). MethodsThe effects of MARS-artificial liver treatments in 19 cases were reviewed. ResultsThe levels of serum total bilirubin, BUN, Cr, urine acid and blood ammonia were greatly reduced by using MARS. Fifteen patients were bridged to transplantation, 1 patient was relieved in symptoms of hepatic encephalopathy after MARS treatment, died 2 weeks after leaving hospital, 1 patient died of severe gastrointestinal bleeding before transplantation. The survival rate is 89.5%.ConclusionMARS artificial liver now is a safe and effective assistant device. It can help to gain more chance of undergoing OLT for the patients.
【Abstract】Objective To evaluate effect of artificial liver support system (ALSS) in liver failure and liver transplantation.Methods Forty-four patients with liver failure (including 12 undergoing liver transplantation) were treated with MARS or plasma exchange. The changes of toxic substances and cytokines in blood were detected before and after treatment. Results ALSS therapy achieved a remarkable improvement in clinical symptoms and physical signs. After ALSS treatment, there was a significant decrease in total bilirubin, total bile acid, alanine aminotransferase, creatinine, urea nitrogen, blood ammonia and endotoxin levels(P＜0.05); the levels of serum NO, TNF-α, IL-4 and IL-6 were significantly decreased(P＜0.05); there was no statistical change in erythrocytes, leukocytes and platelets. The survival rate of 30 liver failure patients caused by severe hepatitis B was 60.0%(18/30). Six patients with acute liver failure were successfully performed liver transplantation. Two patients in 6 with acute liver failure after liver transplantation survived. One patient in 2 with acute liver failure after pancreatoduodenectomy survived. Conclusion ALSS plays a positive role in treatment of liver failure by removing blood toxins, NO and cytokines. ALSS also plays a substitute role for liver failure patients who are waiting for liver transplantation.
ObjectiveTo learn the outcomes of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) cases after artificial liver support system (ALSS) treatment and the relevant factors correlated with the clinical outcomes. MethodsIn the period from January 2011 to June 2014, 321 patients with HBV-ACLF were admitted to West China Hospital. The clinical data at baseline, before and after treatment were analyzed by univariate and multivariate logistic regressions to identify the independent risk factors correlated with 30-day outcomes. ResultsOf all the 321 patients, 233 survived and 88 died by the end of a 30-day observation. The univariate analysis identified that the incidences of cirrhosis, hepatorenal syndrome and peritonitis in the death group were significantly higher (P<0.05). The model for end-stage liver disease values, white blood cells (WBC), blood ammonia, creatinine and total bilirubin (TBIL) at different stages in the death group were significantly higher than those in the survival group (P<0.05). In the death group, the HBV-DNA, TBIL decrease after triple ALSS treatments, baseline prothrombin time activity (PTA) and PTA level after triple ALSS treatments were significantly lower (P<0.05). The multivariate logistic regression indicated that WBC (OR=2.337, P<0.001) and TBIL level after triple ALSS treatments (OR=4.935, P<0.001) were independent predicting factors for death within 30 days after ALSS treatment; HBV-DNA (OR=0.403, P<0.001), the decrease of TBIL after triple ALSS treatments (OR=0.447, P<0.001) and PTA level after triple ALSS treatments (OR=0.332, P<0.001) were protecting factors for the 30-day prognosis. ConclusionThese five factors including WBC, HBV-DNA, PTA, TBIL and TBIL decrease after triple ALSS treatments influence the short-term prognosis for HBV-ACLF patients, which are valuable for decision making in clinical practices.
The main treatment strategies for hepatic failure include drug therapy, artificial liver support system, and liver transplantation. This article introduces the clinically commonly used non biological artificial liver techniques, including plasma exchange, continuous blood purification, plasma bilirubin adsorption, plasma diafiltration, repeatedly pass albumin dialysis, molecular adsorbent recirculating system, Prometheus system, etc; and discusses how to select different artificial liver techniques according to different clinical manifestation. At the same time, the progress of bioartificial liver in recent years is summarized, and the future development of artificial liver is prospected.
Hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) has the characteristics of rapid progress and high mortality. Artificial liver support system (ALSS) is far superior to standard drug therapy in the treatment of such patients, and is widely used in emergency. ALSS is the use of external mechanical or biological devices to replace a part of the damaged liver function, divided into bioartificial, non-bioartificial liver and a combination of the two. At present, there is no unified sensitive prognostic index and recognized prognostic model for HBV-ACLF in artificial liver treatment. This paper reviews the research progress of prognosis evaluation of ALSS in the treatment of HBV-ACLF, in order to provide reference for clinicians and researchers
Understanding the mass transfer behaviors in hollow fiber membrane module of artificial liver is important for improving toxin removal efficiency. A three-dimensional numerical model was established to study the mass transfer of small molecule bilirubin and macromolecule bovine serum albumin (BSA) in the hollow fiber membrane module. Effects of tube-side flow rate, shell-side flow rate, and hollow fiber length on the mass transfer of bilirubin and BSA were discussed. The simulation results showed that the clearance of bilirubin was significantly affected by both convective and diffusive solute transport, while the clearance of macromolecule BSA was dominated by convective solute transport. The clearance rates of bilirubin and BSA increasd with the increase of tube-side flow rate and hollow fiber length. With the increase of shell-side flow rate, the clearance rate of bilirubin first rose rapidly, then slowly rose to an asymptotic value, while the clearance rate of BSA gradually decreased. The results can provide help for designing structures of hollow fiber membrane module and operation parameters of clinical treatment.