Cytokine Level Modifications: Molecular Adsorbent Recirculating System Versus Standard Medical Therapy

• Published in: Transplantation proceedings 2009-05, Vol.41 (4), p.1243-1248
• Main Authors: Novelli, G, Annesini, M.C, Morabito, V, Cinti, P, Pugliese, F, Novelli, S, Piemonte, V, Turchetti, L, Rossi, M, Berloco, P.B
• Format: Article
• Language: English
• Subjects: Adsorption; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cytokines - blood; Emergency and intensive care: renal failure. Dialysis management; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Intensive care medicine; Liver Failure - blood; Liver Failure - physiopathology; Liver Failure - therapy; Liver Regeneration; Male; Medical sciences; Middle Aged; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.03.035

Abstract Introduction Acute-on-chronic liver failure (ACLF) is a systemic inflammatory reaction, which is characterized by a predominantly proinflammatory cytokine profile, causing the transition from stable cirrhosis to ACLF. The aim of the present study was to evaluate the changes in several cytokines associated with inflammatory liver disease and liver regeneration among 15 ACLF patients treated with the Molecular Adsorbent Recirculating System (MARS) compared with 15 patients treated with standard medical therapy (SMT). The subjects showed various disease etiologies but similar values for Model End-stage Liver Disease scores. Methods In the MARS group, 15 (10 male and 5 female) patients were treated with MARS (Gambro). The number of MARS applications was nine; the length of applications was 8 hours. In the SMT group; 15 (10 male and 5 female) patients were treated with SMT. The patients were monitored for 30 days from inclusion with a survival follow-up at 3 months. Statistical results were calculated with SPSS14.0 (SPSS Inc, Chicago, Ill). A P < .07 was considered significant. Results In the MARS group, we observed significant changes in the levels of Interleukin (IL)-6, IL-1, IL-10, and tumor necrosis factor (TNF)-α in association with improved hepatocyte growth factor. Patient survival at 3 months was 60%. The SMT group showed only a significant change in TNF-α ( P = .03). Patient survival at 3 months was 30%. Conclusion The MARS liver support device corrected pathophysiologies of ALF and may be used to enhance spontaneous recovery or as a bridge to transplantation.