The Use Prometheus FPSA System in the Treatment of Acute Liver Failure: Preliminary Results

• Published in: Transplantation proceedings 2006, Vol.38 (1), p.209-211
• Main Authors: Skwarek, A., Grodzicki, M., Nyckowski, P., Kotulski, M., Zieniewicz, K., Michalowicz, B., Patkowski, W., Grzelak, I., Paczkowska, A., Giercuszkiewicz, D., Sańko-Resmer, J., Pączek, L., Krawczyk, M.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biomarkers - blood; Equipment Design; Extracorporeal Circulation - instrumentation; Extracorporeal Circulation - methods; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver Failure, Acute - blood; Liver Failure, Acute - mortality; Liver Failure, Acute - therapy; Liver Function Tests; Liver Transplantation - physiology; Liver, Artificial; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Other diseases. Semiology; Sorption Detoxification; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Tachycardia - epidemiology; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.12.011

The preliminary outcomes of patients with acute liver failure treated with the Prometheus Fractionated Plasma Separation and Absorption (FPSA) system are presented herein. The procedures were performed in 13 patients (4, intoxication by Amanita phalloides; 4, unknown reason; 3, acetaminophen intoxication; 1, Wilson disease, and 1, liver insufficiency after hemihepatectomy owing to metastases of colon adenocarcinoma). The patients were qualified for the procedure according to the King’s College Hospital criteria. The patients’ general status was assessed on basic of GCS, UNOS, and the 4-grade encephalopathy classifications. The procedures were performed with the Prometheus 4008H Fresenius Medical Care unit. The 29 procedures were of mean duration 6.5 hours. There were statistically significant reductions in total bilirubin, ammonia, and aminotransferase levels. In addition, the procedures corrected water, mineral, and carbohydrate disorders. One patient did not require liver transplantation. Seven patients received liver transplants: three patients with positive outcomes; two died due to septicemia within 30 days perioperatively, one died at 6 months after OLT owing to respiratory failure; and one, owing to hemorrhagic diathesis. Four patients did not receive a liver transplant because of lack of a organ, no consent for the surgery, or neoplastic disease with metastases. The Prometheus FPSA-System was an effective detoxication method for patients with acute liver failure. The system was useful as a symptomatic treatment before liver transplantation allowing a longer wait for a graft.