EC Gastroenterology and Digestive System

Mini Review Volume 10 Issue 6 - 2023

Is Albumin Dialysis a Viable Option in Acute Liver Failure and Other Liver Pathologies?

Harshavardhan Sanekommu1*, Sobaan Taj1, Rida Mah Noor2, Muhammad Umair Akmal3, Reza Akhtar4, Mohammad Hossain1 and Arif Asif1

1Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA

2International University of Kyrgyzstan-International School of Medicine, Eastern Campus, Bishkek, Kyrgyzstan

3Kazakh National Medical University, Almaty, Kazakhstan

4Department of Gastroenterology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA

*Corresponding Author: Harshavardhan Sanekommu, Internal Medicine Resident, Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA.
Received: May 17, 2023; Published: June 16, 2023



Acute liver failure (ALF) is associated with a significant 3-month mortality rate of up to 47%. Effective management of ALF requires accurate identification of the underlying cause, careful assessment of encephalopathy severity, and proficient management of potential complications. Liver transplantation is the recommended treatment option for patients with a low probability of spontaneous recovery. This approach has demonstrated consistently positive outcomes reported in both short- and long-term studies. However, for patients with liver failure awaiting transplantation or recovery, albumin dialysis (an extracorporeal nonbiologic liver support system most extensively researched) is considered the most effective option for bridge or destination therapy. Molecular adsorbent recirculating system (MARS) and fractionated plasma separation and absorption device (Prometheus) are two albumin dialysis systems that have been clinically applied to a variety of liver pathologies. This paper provides a narrative review of the various applications of these devices, with a particular focus on their efficacy in the management of ALF and acute-on-chronic liver failure.

Keywords: Albumin Dialysis; MARS; Promethus; Acute Liver Failure; Acute on Chronic Liver Failure

  1. Adam René., et al. “Evolution of Indications and Results of Liver Transplantation in Europe. A Report from the European Liver Transplant Registry (ELTR)”. Journal of Hepatology3 (2012): 675-688.
  2. Oketani Makoto., et al. “Changing Etiologies and Outcomes of Acute Liver Failure: A Perspective from Japan”. Journal of Gastroenterology and Hepatology 26 (2011): 65-71.
  3. Lee William M. “Etiologies of Acute Liver Failure”. Seminars in Liver Disease2 (2008): 142-152.
  4. Bernuau Jacques., et al. “Fulminant and Subfulminant Liver Failure: Definitions and Causes”. Seminars in Liver Disease02 (1986): 97-106.
  5. Jochmans Ina., et al. “Adult Liver Allocation in Eurotransplant”. Transplantation7 (2017): 1542-1550.
  6. Tandon Radhika and Saied Froghi. “Artificial Liver Support Systems”. Journal of Gastroenterology and Hepatology5 (2021): 1164-1179.
  7. Struecker Benjamin., et al. “Liver Support Strategies: Cutting-Edge Technologies”. Nature Reviews Gastroenterology and Hepatology3 (2014): 166-176.
  8. Rifa Kinan Thomas Ernst., et al. “Prometheus--a New Extracorporeal System for the Treatment of Liver Failure”. Journal of Hepatology6 (2003): 984-990.
  9. Mitzner Steffen R. “Extracorporeal Liver Support-Albumin Dialysis with the Molecular Adsorbent Recirculating System (MARS)”. Annals of Hepatology1 (2011): S21-S28.
  10. Saliba Faouzi., et al. “Albumin Dialysis with a Noncell Artificial Liver Support Device in Patients With Acute Liver Failure”. Annals of Internal Medicine8 (2013): 522.
  11. Ilonen Ilkka., et al. “Cytokine Profiles in Acute Liver Failure Treated with Albumin Dialysis”. Artificial Organs (2007): 070802063815003.
  12. Schmidt LE., et al. “Effect of Treatment with the Molecular Adsorbents Recirculating System on Arterial Amino Acid Levels and Cerebral Amino Acid Metabolism in Patients with Hepatic Encephalopathy”. Scandinavian Journal of Gastroenterology10 (2004): 974-980.
  13. Camus Christophe., et al. “Liver Transplantation Avoided in Patients with Fulminant Hepatic Failure Who Received Albumin Dialysis with the Molecular Adsorbent Recirculating System While on the Waiting List: Impact of the Duration of Therapy”. Therapeutic Apheresis and Dialysis6 (2009): 549-555.
  14. Larsen Fin Stolze., et al. “High-Volume Plasma Exchange in Patients with Acute Liver Failure: An Open Randomised Controlled Trial”. Journal of Hepatology1 (2016): 69-78.
  15. MacDonald Andrew J., et al. “Use of the Molecular Adsorbent Recirculating System in Acute Liver Failure: Results of a Multicenter Propensity Score-Matched Study*”. Critical Care Medicine2 (2022): 286-295.
  16. Sen Sambit., et al. “Pathophysiological Effects of Albumin Dialysis in Acute-on-Chronic Liver Failure: A Randomized Controlled Study”. Liver Transplantation9 (2004): 1109-1119.
  17. Heemann Uwe., et al. “Albumin Dialysis in Cirrhosis with Superimposed Acute Liver Injury: A Prospective, Controlled Study”. Hepatology4 (2002): 949-958.
  18. Bañares, Rafael Frederik Nevens., et al. “Extracorporeal Albumin Dialysis with the Molecular Adsorbent Recirculating System in Acute-on-Chronic Liver Failure: The RELIEF Trial”. Hepatology3 (2013): 1153-1162.
  19. Vaid Arjun., et al. “Molecular Adsorbent Recirculating System as Artificial Support Therapy for Liver Failure”. ASAIO Journal1 (2012): 51-59.
  20. Stutchfield BM., et al. “Systematic Review and Meta-Analysis of Survival Following Extracorporeal Liver Support”. British Journal of Surgery5 (2011): 623-631.
  21. Liu Yong., et al. “[Artificial and Bioartificial Liver Support Systems for Acute and Acute-on-Chronic Liver Failure: A Meta-Analysis]”. Nan Fang Yi Ke Da Xue Xue Bao = Journal of Southern Medical University8 (2009): 1529-1532.
  22. Bañares Rafael Luis Ibáñez-Samaniego., et al. “Meta-Analysis of Individual Patient Data of Albumin Dialysis in Acute-on-Chronic Liver Failure: Focus on Treatment Intensity”. Therapeutic Advances in Gastroenterology 12 (2019): 175628481987956.
  23. Mitzner Steffen R., et al. “Improvement of Hepatorenal Syndrome with Extracorporeal Albumin Dialysis Mars: Results of a Prospective, Randomized, Controlled Clinical Trial”. Liver Transplantation3 (2003): 277-286.
  24. Hassanein Tarek I., et al. “Randomized Controlled Study of Extracorporeal Albumin Dialysis for Hepatic Encephalopathy in Advanced Cirrhosis”. Hepatology6 (2007): 1853-1862.
  25. Parés Albert., et al. “Treatment of Resistant Pruritus from Cholestasis with Albumin Dialysis: Combined Analysis of Patients from Three Centers”. Journal of Hepatology2 (2010): 307-312.
  26. Leckie P., et al. “Out-Patient’ Albumin Dialysis for Cholestatic Patients with Intractable Pruritus”. Alimentary Pharmacology and Therapeutics6 (2012): 696-704.
  27. Drolz Andreas., et al. “Extracorporeal Artificial Liver Support in Hypoxic Liver Injury”. Liver International 31 (2011): 19-23.
  28. Banayosy A El., et al. “First Use of the Molecular Adsorbent Recirculating System Technique on Patients with Hypoxic Liver Failure After Cardiogenic Shock”. ASAIO Journal4 (2004): 332-337.
  29. Gilg S., et al. “Albumin Dialysis with Mars in Post-Hepatectomy Liver Failure (PHLF): Experiences from Two HPB Centers”. HPB 18 (2016): e691.
  30. Connor-Schuler Randi L., et al. “The Efficacy of Albumin Dialysis in the Reversal of Refractory Vasoplegic Shock Due to Amlodipine Toxicity”. Critical Care Explorations6 (2020): e0120.
  31. Narayanan Mechu., et al. “The Efficacy of Albumin Dialysis in the Treatment of Severe Cholestatic Drug-Induced Liver Injury”. Critical Care Explorations8 (2022): e0752.
  32. Eapen Jaishvi., et al. “The Efficacy of Extracorporeal Liver Support with Molecular Adsorbent Recirculating System in Severe Drug-Induced Liver Injury”. Oxford Medical Case Reports 1 (2018): omx077.
  33. Evenepoel Pieter., et al. “Prometheus Versus Molecular Adsorbents Recirculating System: Comparison of Efficiency in Two Different Liver Detoxification Devices”. Artificial Organs4 (2006): 276-284.
  34. Ryska M., et al. “Fractionated Plasma Separation and Adsorption Significantly Decreases Intracranial Pressure in Acute Liver Failure: Experimental Study”. European Surgical Research4 (2009): 230-235.
  35. Grodzicki M., et al. “Results of Treatment of Acute Liver Failure Patients with Use of the Prometheus FPSA System”. Transplantation Proceedings8 (2009): 3079-3081.
  36. Rifai Kinan Anibh Das., et al. “Changes in Plasma Amino Acids During Extracorporeal Liver Support by Fractionated Plasma Separation and Adsorption”. Artificial Organs2 (2010): 166-170.
  37. Oppert Michael., et al. “Extracorporeal Liver Support Therapy with Prometheus in Patients with Liver Failure in the Intensive Care Unit”. Therapeutic Apheresis and Dialysis: Official Peer-Reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy5 (2009): 426-430.
  38. Komardina Ekaterina., et al. “Prometheus Therapy for the Treatment of Acute Liver Failure in Patients after Cardiac Surgery”. Kardiochirurgia i Torakochirurgia Polska = Polish Journal of Cardio-Thoracic Surgery4 (2017): 230-235.
  39. Evenepoel Pieter., et al. “Detoxifying Capacity and Kinetics of Prometheus--a New Extracorporeal System for the Treatment of Liver Failure”. Blood Purification5 (2005): 349-358.
  40. Kribben Andreas., et al. “Effects of Fractionated Plasma Separation and Adsorption on Survival in Patients with Acute-on-Chronic Liver Failure”. Gastroenterology4 (2012): 782-789.e3.
  41. Rifai Kinan Carsten Hafer., et al. “Treatment of Severe Refractory Pruritus with Fractionated Plasma Separation and Adsorption (Prometheus)”. Scandinavian Journal of Gastroenterology10 (2006): 1212-1217.
  42. Laleman Wim., et al. “Effect of the Molecular Adsorbent Recirculating System and Prometheus Devices on Systemic Haemodynamics and Vasoactive Agents in Patients with Acute-on-Chronic Alcoholic Liver Failure”. Critical Care4 (2006): R108.
  43. Matar Abraham J and Ram Subramanian. “Extracorporeal Liver Support: A Bridge to Somewhere”. Clinical Liver Disease6 (2021): 274-279.

Harshavardhan Sanekommu., et al. "Is Albumin Dialysis a Viable Option in Acute Liver Failure and Other Liver Pathologies?". EC Gastroenterology and Digestive System  10.6 (2023): 12-19.

ECronicon Journal

Our Services

Quick Links

Information

Creative Commons LicenseOpen Access by ECronicon is licensed under a Creative Commons Attribution 4.0 International License
Based on a work at www.ecronicon.net