Although liver transplantation has become standard procedure for patients with liver failure, a number of issues in the management of these patients remains to be addressed. Alternative approaches have been tested, such as hepatocytes containing liver-support systems and filtration devices. However, the replacement of detoxification has been difficult, as the majority of toxins accumulating in liver failure is albumin-bound. Albumin dialysis (MARS system) is characterized by the specific removal of albumin-bound toxins through an innovative membrane transport. In particular, the albumin acts as a specific molecular adsorbent that is regenerated on line in a recycling system. Nowadays MARS represents the most frequently used liver support system. This treatment has been shown to remove albumin-bound molecules, such as bilirubin, bile acids, aromatic amino acids and copper. The removal of these toxins is clinically accompanied with an improvement of liver, cardiovascular and renal functions and hepatic encephalopathy. In several trials MARS was found to improve the clinical situation in patients with acute exacerbation of chronic liver failure and acute hepatic failure, but also in hepatorenal syndrome and primary graft non function or chronic rejection after liver transplantation. In summary, a critical analysis of the literature confirms that MARS device can be a safe therapeutic choice to achieve a better clinical outcome, and, sometimes, a survival advantage in patients with liver failure, even if a multi-center randomized trial is the only reliable way to enforce today's results. Further advances in the MARS components will definitively state whether albumin dialysis may represent the future in the field of artificial liver devices.

Di Campli, C., Zileri Dal Verme, L., Andrisani, M. C., Armuzzi, A., Candelli, M., Gaspari, R., Gasbarrini, A., A) Advances in extracorporeal detoxification by MARS dialysis in patients with liver failure, <<CURRENT MEDICINAL CHEMISTRY>>, 2003; (10(4)): 341-348 [http://hdl.handle.net/10807/20686]

A) Advances in extracorporeal detoxification by MARS dialysis in patients with liver failure

Di Campli, Cristiana;Zileri Dal Verme, Lorenzo;Andrisani, Maria Carmela;Armuzzi, Alessandro;Candelli, Marcello;Gaspari, Rita;Gasbarrini, Antonio
2003

Abstract

Although liver transplantation has become standard procedure for patients with liver failure, a number of issues in the management of these patients remains to be addressed. Alternative approaches have been tested, such as hepatocytes containing liver-support systems and filtration devices. However, the replacement of detoxification has been difficult, as the majority of toxins accumulating in liver failure is albumin-bound. Albumin dialysis (MARS system) is characterized by the specific removal of albumin-bound toxins through an innovative membrane transport. In particular, the albumin acts as a specific molecular adsorbent that is regenerated on line in a recycling system. Nowadays MARS represents the most frequently used liver support system. This treatment has been shown to remove albumin-bound molecules, such as bilirubin, bile acids, aromatic amino acids and copper. The removal of these toxins is clinically accompanied with an improvement of liver, cardiovascular and renal functions and hepatic encephalopathy. In several trials MARS was found to improve the clinical situation in patients with acute exacerbation of chronic liver failure and acute hepatic failure, but also in hepatorenal syndrome and primary graft non function or chronic rejection after liver transplantation. In summary, a critical analysis of the literature confirms that MARS device can be a safe therapeutic choice to achieve a better clinical outcome, and, sometimes, a survival advantage in patients with liver failure, even if a multi-center randomized trial is the only reliable way to enforce today's results. Further advances in the MARS components will definitively state whether albumin dialysis may represent the future in the field of artificial liver devices.
Inglese
Di Campli, C., Zileri Dal Verme, L., Andrisani, M. C., Armuzzi, A., Candelli, M., Gaspari, R., Gasbarrini, A., A) Advances in extracorporeal detoxification by MARS dialysis in patients with liver failure, <<CURRENT MEDICINAL CHEMISTRY>>, 2003; (10(4)): 341-348 [http://hdl.handle.net/10807/20686]
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/20686
Citazioni
  • ???jsp.display-item.citation.pmc??? 3
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact