ABSTRACTS from 16th International COnference on ... - CRRT Online
ABSTRACTS from 16th International COnference on ... - CRRT Online
ABSTRACTS from 16th International COnference on ... - CRRT Online
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Combined <strong>CRRT</strong>-bilibrubin Adsorpti<strong>on</strong> System for Liver Failure<br />
Educati<strong>on</strong>al Objectives:<br />
1. Overview the usually used artificial liver support systems<br />
2. Discuss the mechanisms of toxins removal in liver support systems<br />
3. Introduce a novel system: combined <strong>CRRT</strong>-bilirubin adsorpti<strong>on</strong> system<br />
Zhi-H<strong>on</strong>g Liu MD<br />
8:15-8:30<br />
Friday, February 17<br />
C<strong>on</strong>tent Descripti<strong>on</strong>:<br />
Liver failure is a severe complicati<strong>on</strong> presented in critically ill patients, often with high mortality. Artificial liver<br />
support (ALS) usually serves to replace part of liver’s detoxicati<strong>on</strong> functi<strong>on</strong> by eliminati<strong>on</strong> of toxins accumulated<br />
in body after liver failure <str<strong>on</strong>g>from</str<strong>on</strong>g> circulati<strong>on</strong>, and bridges patients to liver functi<strong>on</strong> recovery or transplantati<strong>on</strong>. The<br />
ALS modalities include biological ALS, n<strong>on</strong>-bio ALS, and hybrid ALS. Am<strong>on</strong>g them, n<strong>on</strong>-bio ALS is the most<br />
comm<strong>on</strong>ly used <strong>on</strong>e. Protein-bound toxins like bilirubin are the major targets for removal by ALS. Molecular<br />
adsorpti<strong>on</strong> recycling system (MARS) removes bilirubin using albumin as dialysate, through a process limited by<br />
bilirubin dissociati<strong>on</strong> and diffusi<strong>on</strong>, with a clearance rate around 14 ml/min. Fracti<strong>on</strong>ated plasma separati<strong>on</strong> and<br />
adsorpti<strong>on</strong> (Prometheus) system removes bilirubin using an albumin-leakage filter as dialyzer, through a process<br />
limited by albumin diffusi<strong>on</strong>, with a clearance rate around 20ml/min. Herein we reported a novel system for liver<br />
support: combined <strong>CRRT</strong>-bilirubin adsorpti<strong>on</strong> system. In this system, a fracti<strong>on</strong> plasma separator is used and<br />
albumin c<strong>on</strong>vecti<strong>on</strong> process is employed. A plasma-based water-exchange system is integrated into it for removal<br />
of water-soluble toxins. With this system, a clearance rate for bilirubin around 25-30ml/min can be reached.<br />
Suggested Reading:<br />
1. Lee WM, Squires RH Jr, Nyberg SL, et al. Acute liver failure: Summary of a workshop. Hepatology<br />
2008,47: 1401-1415<br />
2. Hassanein TI, Schade RR, Hepburn IS. Acute-<strong>on</strong>-chr<strong>on</strong>ic liver failure: extracorporeal liver assist devices.<br />
Curr Opin Crit Care. 2011<br />
3. G<strong>on</strong>g D, Cruz D, R<strong>on</strong>co C. Depurative capacity of molecular adsorbent recycling system(MARS): a focus <strong>on</strong><br />
bilirubin removal. Int J Artif Organs 2008,31: 875-81<br />
4. Evenepoel P, Laleman W, Wilmer A, et al. Prometheus Versus Molecular Adsorbents Recirculating System:<br />
Comparis<strong>on</strong> of Efficiency in Two Different Liver Detoxificati<strong>on</strong> Devices. Artificial Organs 2006, 30(4):276–284<br />
5. Evenepoel P, Laleman W, Wilmer A, et al. Detoxifying Capacity and Kinetics of Prometheus ® – A New<br />
Extracorporeal System for the Treatment of Liver Failure. Blood Purif 2005?23:349–358<br />
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