Molecular adsorbent recycling system in treat-ing patients with acute liver failure: a bridge to liver transplantation

BACKGROUND:Acute liver failure is still a life-threaten- ing disease although it can be treated by liver transplanta- tion. This study was conducted to assess the molecular ad- sorbent recycling system (MARS), which may bridge acute liver failure patients to liver transplantation. METHODS: Biochemical indexes and other clinical data were analyzed of 8 patients with acute liver failure, who had been treated by MARS for 34 times and subsequent Piggyback liver transplantation. RESULTS: After treatment with MARS, the levels of tran- saminase and total bilirubin decreased markedly, but coagu- lation function remained unimproved. All patients survived and discharged from the hospital. CONCLUSION: MARS is effective in bridging patients with acute liver failure to liver transplantation.

Survival predictors in patients treated with a molecular adsorbent recirculating system

AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system(MARS). METHODS:MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery,and as a bridge to liver transplantation(LTX).We analyzed the 1-year outcomes of 188 patients treated with MARS,from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic,clinical and laboratory parameters were recorded before and after each treatment.One-year survival and the number of LTXs were recorded.Logistic regression analysis was performed to determine factors predicting survival. RESULTS:The study included 113 patients with acute liver failure(ALF),62 with acute-on-chronic liver failure(AOCLF),11 with graft failure(GF),and six with miscellaneous liver failure.LTX was performed for 29% of patients with ALF,18% with AOCLF and 55%with GF.The overall 1-year survival rate was 74% for ALF,27% for AOCLF,and 73% for GF.The poorest survival rate,6%,was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis,whereas,patients with enlarged and steatotic liver had 55% survival.The etiology of liver failure was the most important predictor of survival(P<0.0001).Other prognostic factors were encephalopathy(P=0.001)in paracetamol-related ALF, coagulation factors(P=0.049)and encephalopathy(P=0.064)in non-paracetamol-related toxic ALF,and alanine aminotransferase(P=0.013)and factor V levels(P =0.022)in ALF of unknown etiology. CONCLUSION:The etiology of liver disease was the most important prognostic factor.MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.

Artificial liver support molecular adsorbents recirculating system therapy as a bridge to re-transplantation in two cases of long anhepatic duration

BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support therapy as a bridge to re-transplantation in two cases of long anhepatic duration. METHODS: MARS therapy was given after failure plasma- exchange ( PE) treatment, which resulted in circulatory de- rangement and acute renal dysfunction in a 36-year-old male patient. Finally his uncontrolled anhepatic condition led to a successful re-transplantation. In another 48-year- old man who was diagnosed as having primary nonfunction (PNF) during the liver transplantation, 10-hour MARS treatment contributed to smooth bridging of his anhepatic phase. RESULTS: The two anhepatic patients were bridged for 26 and 17 hours respectively to re-transplantation with MARS therapy. CONCLUSION: Our experience proves that MARS artifi- cial liver can be an effective support for long time bridging PNF until re-transplantation is available.

Efficient adsorption separation of methane from C_(2)-C_(3) hydrocarbons in a Co(Ⅱ)-nodes metal-organic framework

Methane(CH_(4))as a substitute for other mineral fuels plays a crucial role in reducing energy consumption and preventing environmental pollution.The present study employs a solvothermal method to fabricate a porous framework Co-metal-organic framework(Co-MOF)containing two distinct secondary building units(SBUs):an anionic[Co_(2)(μ_(2)-OH)(COO)_(4)(H_(2)O)]and a neutral[CoN_(2)(COO)_(2)].Notably,within the anionic SBUs,the coordinated water molecules induce the generation of divergent unsaturated Co(Ⅱ)centers in the unidirectional porous channels,thereby creating open metal sites.The adsorption performance of Co-MOF towards pure component gases was systematically investigated.The results demonstrated that Co-MOF exhibits superior adsorption capacity for C_(2)-C_(3) hydrocarbons compared to CH_(4),which offers the potential for efficient adsorption and separation of CH_(4) from C_(2)-C_(3) hydrocarbons.The gas selectivity separation ratios of Co-MOF for C_(2)H_(6)/CH_(4) and C_(3)H_8/CH_(4) were calculated using the ideal adsorbed solution theory method at 273/298 K and 0.1 MPa.The results revealed that Co-MOF achieved remarkable equilibrium separation selectivity for CH_(4) and C_(2)-C_(3) hydrocarbon gases among non-modified MOFs,signifying the potential of the synthesized Co-MOF for efficient recovery and purification of CH_(4) from C_(2)-C_(3) hydrocarbons.Breakthrough experiments further demonstrate the ability of Co-MOF to purify methane from C_(2)-C_(3) hydrocarbons in practical gas separation scenarios.Additionally,molecular simulation calculations further substantiate the propensity of anionic SBUs to interact with C_(2)-C_(3) hydrocarbon compounds.This study provides a novel paradigm for the development of porous MOF materials in the application of gas mixture separation.

Effect of Prometheus liver assist system on systemic hemodynamics in patients with cirrhosis: A randomized controlled study

AIM： To evaluate treatment safety and hemodynamic changes during a single 6-h treatment with the PrometheusTM liver assist system in a randomized, controlled study. METHODS： Twenty-four patients were randomized to either the study group or to one of two control groups： Fractionated Plasma Separation Adsorption and Dialysis, PrometheusTM system （Study group; n = 8）; Molecular Adsorbent Recirculation System （MARS）TM （Control group 1, n = 8）; or hemodialysis （Control group 2; n = 8）. All patients included in the study had decompensated cirrhosis at the time of the inclusion into the study. Circulatory changes were monitored with a Swan-Ganz catheter and bilirubin and creatinine were monitored as measures of protein-bound and water-soluble toxins. RESULTS： Systemic hemodynamics did not differ between treatment and control groups apart from an increase in arterial pressure in the MARS group （P = 0.008）. No adverse effects were observed in any of the groups. Creatinine levels significantly decreased in the MARS group （P = 0.03） and hemodialysis group （P = 0.04）. Platelet count deceased in the Prometheus group （P = 0.04）.CONCLUSION： Extra-corporal liver support with Prometheus is proven to be safe in patients with endstage liver disease but does not exert the beneficial effects on arterial pressure as seen in the MARS group,

Extracorporeal liver support in severe alcoholic hepatitis

The severity of alcoholic hepatitis(AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalities, to severe forms characterised by deep jaundice, ascites, hepatic encephalopathy and low prothrombin index. In hospitalized patients the mortality could be as high as 75%. The elevated number of therapeutic proposals reported for more than forty years reveals the lack of efficacy of a particular modality. Even in the most favorable trials, the survival is already very poor and in some cases related to the development of renal failure or hepatorenal syndrome. There are some motivating reports concerning albumin dialysis as a support treatment in patients with severe AH, either alone or in combination with other pharmacological therapies. The favorable effects of albumin dialysis in patients with severe AH suggest that the procedure used alone or in combination with other therapies may have a role in this clinical condition. This will be particularly relevant to offer an alternative therapy in these patients, thus being a potential bridge to recovery or to be listed for liver transplantation.

Assessment of prognosis and curative effect in patients with chronic severe hepatitis using the model for end-stage liver disease scores

Severe hepatitis is the most severe liver disease, with poor prognosis and high mortality. We explored the practical use of the model for end-stage liver disease （MELD） on clinical and the molecular adsorbents recirculating system （MARS） on chronic severe hepatitis to predict the short-term prognosis of patients with chronic severe hepatitis using the MELD score and the curative effect of MARS treatment.