Liver Transplantation Avoided in Patients With Fulminant Hepatic Failure Who Received Albumin Dialysis With the Molecular Adsorbent Recirculating System While on the Waiting List: Impact of the Duration of Therapy
Identifieur interne : 001663 ( Istex/Curation ); précédent : 001662; suivant : 001664Liver Transplantation Avoided in Patients With Fulminant Hepatic Failure Who Received Albumin Dialysis With the Molecular Adsorbent Recirculating System While on the Waiting List: Impact of the Duration of Therapy
Auteurs : Christophe Camus [France] ; Sylvain Lavoué ; Arnaud Gacouin ; Philippe Compagnon ; Karim Boudjéma ; Christian Jacquelinet [France] ; Rémi Thomas ; Yves Le Tulzo [France]Source :
- Therapeutic Apheresis and Dialysis [ 1744-9979 ] ; 2009-12.
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Abstract
Eighteen patients with fulminant hepatic failure due to various medical causes were listed for emergency liver transplantation and treated with extracorporeal albumin dialysis sessions using the molecular adsorbent recirculating system (MARS) at our center over a 74‐month period. Due to improvement of liver function, transplantation could be avoided in 9 patients (50%, 95% confidence interval 29% to 71%) who fully recovered afterwards. This improvement rate was higher than the rate of improvement in the French cohort of fulminant hepatic failure patients with similar etiologies (19.3%, 95% confidence interval 14.9% to 24.6%, P = 0.002). In our 18 patients, there were no statistically significant differences in any baseline characteristics or in the time with liver failure meeting transplant criteria between the patients who improved while waiting and those who did not. However, the patients who improved received a greater number of sessions and a longer total duration of MARS therapy (all P < 0.001). In the whole study population, a MARS therapy duration ≥15 h was significantly associated with improvement of liver function without transplantation (adjusted adds ratio [OR] 65.76, 2.48–1743.11, P = 0.01). Tolerance of therapy was acceptable. These results suggest that MARS therapy could contribute to native liver recovery and is safe in patients on the waiting list for fulminant hepatic failure. A minimum duration of therapy (≥15 h) could be necessary to expect significant liver function improvement.
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DOI: 10.1111/j.1744-9987.2009.00708.x
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Sylvain Lavoué<affiliation><mods:affiliation>Infectious Diseases and Intensive Care Medicine, Pontchaillou Hospital,</mods:affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation><affiliation><mods:affiliation>Infectious Diseases and Intensive Care Medicine, Pontchaillou Hospital,</mods:affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation><affiliation><mods:affiliation>Department of Digestive Surgery, Pontchaillou Hospital, University Hospital Center Rennes (CHRU), Rennes, and</mods:affiliation><wicri:noCountry code="subField">and</wicri:noCountry></affiliation><affiliation><mods:affiliation>Department of Digestive Surgery, Pontchaillou Hospital, University Hospital Center Rennes (CHRU), Rennes, and</mods:affiliation><wicri:noCountry code="subField">and</wicri:noCountry></affiliation><affiliation><mods:affiliation>Infectious Diseases and Intensive Care Medicine, Pontchaillou Hospital,</mods:affiliation><wicri:noCountry code="subField"></wicri:noCountry></affiliation>Le document en format XML
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uniqKey="Boudjema K" first="Karim" last="Boudjéma">Karim Boudjéma</name><affiliation><mods:affiliation>Department of Digestive Surgery, Pontchaillou Hospital, University Hospital Center Rennes (CHRU), Rennes, and</mods:affiliation><wicri:noCountry code="subField">and</wicri:noCountry></affiliation></author><author><name sortKey="Jacquelinet, Christian" sort="Jacquelinet, Christian" uniqKey="Jacquelinet C" first="Christian" last="Jacquelinet">Christian Jacquelinet</name><affiliation wicri:level="1"><mods:affiliation>French Biomedicine Agency, Saint‐denis La Plaine, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>French Biomedicine Agency, Saint‐denis La Plaine</wicri:regionArea></affiliation></author><author><name sortKey="Thomas, Remi" sort="Thomas, Remi" uniqKey="Thomas R" first="Rémi" last="Thomas">Rémi Thomas</name><affiliation><mods:affiliation>Infectious Diseases and Intensive Care Medicine, Pontchaillou 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to="555">555</biblScope></imprint><idno type="ISSN">1744-9979</idno></series><idno type="istex">D68B9DB1EEC9728FD60C60EADF843D1B618CB8FC</idno><idno type="DOI">10.1111/j.1744-9987.2009.00708.x</idno><idno type="ArticleID">TAP708</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1744-9979</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Fulminant hepatic failure</term><term>Liver transplantation</term><term>Molecular adsorbent recycling system albumin dialysis</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Eighteen patients with fulminant hepatic failure due to various medical causes were listed for emergency liver transplantation and treated with extracorporeal albumin dialysis sessions using the molecular adsorbent recirculating system (MARS) at our center over a 74‐month period. Due to improvement of liver function, transplantation could be avoided in 9 patients (50%, 95% confidence interval 29% to 71%) who fully recovered afterwards. This improvement rate was higher than the rate of improvement in the French cohort of fulminant hepatic failure patients with similar etiologies (19.3%, 95% confidence interval 14.9% to 24.6%, P = 0.002). In our 18 patients, there were no statistically significant differences in any baseline characteristics or in the time with liver failure meeting transplant criteria between the patients who improved while waiting and those who did not. However, the patients who improved received a greater number of sessions and a longer total duration of MARS therapy (all P < 0.001). In the whole study population, a MARS therapy duration ≥15 h was significantly associated with improvement of liver function without transplantation (adjusted adds ratio [OR] 65.76, 2.48–1743.11, P = 0.01). Tolerance of therapy was acceptable. These results suggest that MARS therapy could contribute to native liver recovery and is safe in patients on the waiting list for fulminant hepatic failure. A minimum duration of therapy (≥15 h) could be necessary to expect significant liver function improvement.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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