Liver Depurative Techniques: A Single Liver Transplantation Center Experience

• Published in: Transplantation proceedings 2015-05, Vol.47 (4), p.996-1000
• Main Authors: Rodrigues, J, Castro, S.G, Moya, B, Fortuna, P, Martins, A, Pereira, J.P, Bento, L, Perdigoto, R, Barroso, E, Marcelino, P
• Format: Article
• Language: English
• Subjects: End Stage Liver Disease - mortality; End Stage Liver Disease - surgery; Female; Follow-Up Studies; Humans; Liver Failure, Acute - mortality; Liver Failure, Acute - surgery; Liver Transplantation - methods; Liver Transplantation - mortality; Male; Middle Aged; Portugal - epidemiology; Retrospective Studies; Surgery; Survival Rate - trends; Time Factors
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2015.03.016

Abstract Background In a liver transplant (LT) center, treatments with Prometheus were evaluated. The main outcome considered was 1 and 6 months survival. Methods During the study period, 74 patients underwent treatment with Prometheus; 64 were enrolled, with a mean age of 51 ± 13 years; 47 men underwent 212 treatments (mean, 3.02 per patient). The parameters evaluated were age, sex, laboratorial (liver enzymes, ammonia) and clinical (model for end-stage liver disease and Child-Turcotte-Pugh score) data. Results Death was verified in 23 patients (35.9%) during the hospitalization period, 20 patients (31.3%) were submitted to liver transplantation, and 21 were discharged. LT was performed in 4 patients with acute liver failure (ALF, 23.7%), in 7 patients with acute on chronic liver failure (AoCLF, 43.7%), and in 6 patients with liver disease after LT (30%). Seven patients who underwent LT died (35%). In the multivariate analysis, older age ( P  = .015), higher international normalized ratio (INR) ( P  = .019), and acute liver failure ( P  = .039) were independently associated with an adverse 1-month clinical outcome. On the other hand, older age ( P  = .011) and acute kidney injury ( P  = .031) at presentation were both related to worse 6-month outcome. For patients with ALF and AoCLF we did not observe the same differences. Conclusions In this cohort, older age was the most important parameter defining 1- and 6-month survival, although higher INR and presence of ALF were important for 1-month survival and AKI for 6-month survival. No difference was observed between patients who underwent LT or did not have LT.