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Ito Y, Nakade J, Seki A, Gabata R, Okazaki M, Nakanuma S, Fujita A, Shimada T, Yamashita T, Yagi S, Taniguchi T, Sai Y. Case report: therapeutic monitoring of vancomycin in an acute liver failure patient with anuria under high-flow continuous hemodiafiltration. J Pharm Health Care Sci 2023; 9:15. [PMID: 37122008 PMCID: PMC10150540 DOI: 10.1186/s40780-023-00283-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND High-flow continuous hemodiafiltration (HF-CHDF) combines diffusive and convective solute removal and is employed for artificial liver adjuvant therapy. However, there is no report on dosage planning of vancomycin (VCM) in patients with acute liver failure under HF-CHDF. CASE PRESENTATION A 20-year-old woman (154 cm tall, weighing 50 kg) was transferred to the intensive care unit (ICU) with acute liver failure associated with autoimmune liver disease. On the following day, HF-CHDF was started due to elevated plasma ammonia concentration. On ICU day 8, VCM was started for suspected pneumonia and meningitis (30 mg/kg loading dose, then 20 mg/kg every 12 hrs). However, on ICU day 10, VCM blood concentration was under the limit of detection (< 3.0 μg/mL) and the patient developed anuria. The VCM dose was increased to 20 mg/kg every 6 hrs. Calculation with a one-compartment model using the HF-CHDF blood flow rate as a surrogate for VCM clearance, together with hematocrit and protein binding ratio, predicted a trough VCM blood concentration of 15 μg/mL. The observed concentration was about 12 μg/mL. The difference may represent non-HF-CHDF clearance. Finally, living donor liver transplantation was performed. CONCLUSION We report an acute liver failure patient with anuria under HF-CHDF in whom VCM administration failed to produce an effective blood concentration, likely due to HF-CHDF-enhanced clearance. VCM dosage adjustment proved successful, and was confirmed by calculation using a one-compartment model.
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Affiliation(s)
- Yuriko Ito
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Junya Nakade
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
- Department of Infection Control and Prevention, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Akihiro Seki
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Ryosuke Gabata
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Mitsuyoshi Okazaki
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shinichi Nakanuma
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Arimi Fujita
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tsutomu Shimada
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Taro Yamashita
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shintaro Yagi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takumi Taniguchi
- Intensive Care Unit, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshimichi Sai
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
- AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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2
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Zhang Y, Dong R, Li Y, Yang X, Liu J, Ou S, Wu W. Efficacy and safety of plasma diafiltration: Review of case reports and case series. Ther Apher Dial 2023; 27:3-11. [PMID: 35437915 DOI: 10.1111/1744-9987.13859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/17/2022] [Accepted: 04/15/2022] [Indexed: 01/05/2023]
Abstract
Plasma diafiltration (PDF), a blood purification procedure that combines dialysis with plasma filtration by a selective membrane, has been used to treat acute liver failure, sepsis, and other acute conditions. We reviewed 14 eligible case reports and case series that examined PDF in 357 patients to assess its efficacy and safety. Fourteen diseases may be indications for PDF. The primary indication in the included studies was acute liver failure without obvious inducement or cause not mentioned. Eighty-three patients reached the primary endpoint (31 deaths, 52 recoveries) and the efficacy was 62.7%. There were large changes in 16 toxins or clinical markers after PDF, including total bilirubin, IL-18, IL-6. In conclusion, PDF appears to be an effective treatment for clearance of bilirubin and other inflammatory mediators in patients with acute liver injury or a disease characterized by a systemic inflammatory state. Randomized controlled trials are needed to compare PDF with other blood purification methods, such as plasma exchange and the Molecular Adsorbent Recirculating System™.
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Affiliation(s)
- Yannan Zhang
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Rui Dong
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Ying Li
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Xin Yang
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Jiang Liu
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Santao Ou
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Weihua Wu
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
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3
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Suzuki G, Ichibayashi R, Yamamoto S, Serizawa H, Nakamichi Y, Watanabe M, Honda M. Plasma filtration with dialysis for the treatment of capillary leak syndrome occurring secondary to surgery for colon cancer-related perforating peritonitis. Clin Case Rep 2021; 9:1490-1493. [PMID: 33768874 PMCID: PMC7981737 DOI: 10.1002/ccr3.3811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/27/2020] [Accepted: 01/04/2021] [Indexed: 12/29/2022] Open
Abstract
The use of plasma filtration with dialysis (PDF) may be considered when treating the acute phase of capillary leak syndrome (CLS). To the best of our knowledge, this is the first report using PDF for CLS.
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Affiliation(s)
- Ginga Suzuki
- Critical Care CenterToho University Omori Medical CenterTokyoJapan
| | - Ryo Ichibayashi
- Critical Care CenterToho University Omori Medical CenterTokyoJapan
| | - Saki Yamamoto
- Critical Care CenterToho University Omori Medical CenterTokyoJapan
| | - Hibiki Serizawa
- Critical Care CenterToho University Omori Medical CenterTokyoJapan
| | | | | | - Mitsuru Honda
- Critical Care CenterToho University Omori Medical CenterTokyoJapan
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Redant S, De Bels D, Ismaili K, Honoré PM. Membrane-Based Therapeutic Plasma Exchange in Intensive Care. Blood Purif 2020; 50:290-297. [PMID: 33091920 DOI: 10.1159/000510983] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/16/2020] [Indexed: 11/19/2022]
Abstract
The principles and use of plasmapheresis are often little understood by intensivists. We propose to review the principles, the main indications, and the methods of using this technique.
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Affiliation(s)
- Sebastien Redant
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium,
| | - David De Bels
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Khalid Ismaili
- Division of Nephrology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Patrick M Honoré
- Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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Odamaki S, Hori Y, Nakai S, Akazawa M, Sato K, Yamada A, Aoki K, Sato H, Miyakawa H, Ishibashi Y. A Solution Kinetics Simulation Method for Conventional and Selective Plasma Exchange Using a Complete Mixed Reactor Model. Ther Apher Dial 2019; 23:266-270. [PMID: 31026124 DOI: 10.1111/1744-9987.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
At present, conventional plasma exchange (CPE) sets removal rate, replacement fluid volume and replacement fluid albumin (Alb) concentration according to the first-order kinetics of mass balance for removal of pathogenic substances. With the spread of selective plasma exchange (SePE), it has become necessary to set the removal rate and replacement fluid Alb concentration based on the initial concentration for each performance of the plasma separator. Considering the patient as a single reactor we devised a complete mixed reactor model simulating the concentration change in the reactor. Our formula is obtained by adding membrane performance and replacement fluid concentration to formulas currently available and can be used for both CPE and SePE. For the in vitro experiment, fresh frozen plasma stored in a bag was used to simulate a patient's circulating plasma. Plasma was separated by plasma separator Evacure EC-4A10 (EC-4A) (Kawasumi Laboratories Inc., Tokyo, Japan) while a replacement Alb solution was simultaneously entered into the circuit at the same rate as separation. IgG, Alb, total protein (TP), and fibrinogen (Fib) concentrations were measured every 10 min and examined for correlation with the value predicted by the mass balance formula. The concentration of each solute was measured 21 times during the 195 min of the experiment. The rate of change of each solute was IgG 76%, Alb 58%, TP 58%, and Fib 32%. Experimental values and predicted values showed significant correlation (IgG: r2 = 0.9962; Fib: r2 = 0.9535; Alb: r2 = 0.9808; TP: r2 = 0.9721, all P < 0.05). Since the solute concentration change in SePE can be predicted, this mass balance formula is useful for setting treatment conditions for both CPE and SePE.
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Affiliation(s)
- So Odamaki
- Department of Clinical Engineering, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuki Hori
- Department of Clinical Engineering, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Sota Nakai
- Department of Clinical Engineering, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Mayumi Akazawa
- Department of Clinical Engineering, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kanako Sato
- Department of Clinical Engineering, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Asuka Yamada
- Department of Clinical Engineering, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kanako Aoki
- Department of Clinical Engineering, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hiroshi Sato
- Department of Clinical Engineering, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hiroyuki Miyakawa
- Department of Clinical Engineering, Japanese Red Cross Medical Center, Tokyo, Japan
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Li M, Sun J, Li J, Shi Z, Xu J, Lu B, Cheng S, Xu Y, Wang X, Zhang X. Clinical observation on the treatment of acute liver failure by combined non-biological artificial liver. Exp Ther Med 2016; 12:3873-3876. [PMID: 28105119 PMCID: PMC5228520 DOI: 10.3892/etm.2016.3887] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/02/2016] [Indexed: 01/30/2023] Open
Abstract
The clinical efficacy and safety of different combinations of non-bio artificial liver in the treatment of acute liver failure was examined. A total of 61 cases were selected under blood purification treatment from the patients with severe acute liver failure admitted to the severe disease department of the hospital from December, 2010 to December, 2015. Three types of artificial liver combinations were observed, i.e., plasma exchange plus hemoperfusion plus continuous venovenous hemodiafiltration (PE+HP+CVVHDF), PE+CVVHDF and HP+CVVHDF. The heart rate (HR), mean arterial pressure (MAP), respiratory index (PaO2/FiO2), liver and kidney function indicator, as well as platelet and coagulation function were compared. A comparison before and after the treatment using the three methods, showed improvement in the HRs, MAPs, PaO2/FiO2, total bilirubins (TBIL) and alanine aminotransferases (ALT) (P<0.05), of which TBIL and ALT were decreased more significantly (P<0.01) in the PE+CVVHDF and PE+HP+CVVHDF groups. Only changes in the PE+HP+CVVHDF and PE+CVVHDF groups were statistically significant after prothrombin time and albumin treatment (P<0.05). The difference between the decrease in TBIL in the PE+HP+CVVHDF group and that in the HP+CVVHDF group was statistically significant (P<0.05). Treatment of the 61 patients using the artificial liver support system yielded a survival rate of 62.3% (38/61), and a viral survival rate of 35.0% (7/20); with the non-viral survival rate being 75.6% (31/41). In conclusion, following the treatment of three types of artificial livers, the function was improved to varying degrees, with the PE+HP+CVVHDF and the PE+CVVHDF method being better. By contrast, after the treatment of non-viral liver failure, the survival rate was significantly higher than the patients with viral liver failure.
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Affiliation(s)
- Maoqin Li
- Department of Intensive Care Unit, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou Clinical School of Xuzhou Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, P.R. China
| | - Jingxi Sun
- Department of Intensive Care Unit, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou Clinical School of Xuzhou Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, P.R. China
| | - Jiaqiong Li
- Department of Intensive Care Unit, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou Clinical School of Xuzhou Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, P.R. China
| | - Zaixiang Shi
- Department of Intensive Care Unit, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou Clinical School of Xuzhou Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, P.R. China
| | - Jiyuan Xu
- Department of Intensive Care Unit, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou Clinical School of Xuzhou Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, P.R. China
| | - Bo Lu
- Department of Intensive Care Unit, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou Clinical School of Xuzhou Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, P.R. China
| | - Shuli Cheng
- Department of Intensive Care Unit, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou Clinical School of Xuzhou Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, P.R. China
| | - Yanjun Xu
- Department of Intensive Care Unit, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou Clinical School of Xuzhou Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, P.R. China
| | - Xiaomeng Wang
- Department of Intensive Care Unit, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou Clinical School of Xuzhou Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, P.R. China
| | - Xianjiang Zhang
- Department of Intensive Care Unit, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou Clinical School of Xuzhou Medical College of Nanjing University of Chinese Medicine, Xuzhou, Jiangsu 221009, P.R. China
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7
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Inoue N, Sato A, Ikawa Y, Shimizu M, Okajima M, Taniguchi T, Yachie A. Successful treatment of exertional heat stroke using continuous plasma diafiltration. J Clin Apher 2015; 31:490-2. [PMID: 26575209 DOI: 10.1002/jca.21439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/07/2015] [Accepted: 10/26/2015] [Indexed: 11/06/2022]
Abstract
We report a case of severe exertional heat stroke with multiple organ failure successfully treated with continuous plasma diafiltration (CPDF). PDF effectively removed proinflammatory cytokines, and simultaneously, supported liver function. Furthermore, CPDF therapy showed beneficial effects on multiple organ functions. These features suggest that it is a primary treatment option for exertional heat stroke with multiple organ failure. J. Clin. Apheresis 31:490-492, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Natsumi Inoue
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Akira Sato
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Yasuhiro Ikawa
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masaki Shimizu
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
| | - Masaki Okajima
- Intensive Care Unit, Kanazawa University Hospital, Kanazawa, Japan
| | - Takumi Taniguchi
- Intensive Care Unit, Kanazawa University Hospital, Kanazawa, Japan
| | - Akihiro Yachie
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Abstract
PURPOSE OF REVIEW Acute liver failure (ALF) is a rare but life-threatening systemic disorder. Survival rates with or without emergency liver transplantation (ELT) are increasing. The benefit of ELT in some cases has been questioned and the potential for survival with medical management alone is changing our approach to the management of this disease. RECENT FINDINGS Survival rates for all causes of ALF are increasing because of improvements in the care of the critically ill patient. A multifactorial approach involving support of respiratory, circulatory and renal function together with measures to avoid intracranial hypertension, metabolic disequilibrium and sepsis are required. For those who do not respond to these measures or specific antidotes, the selection methods for those likely to benefit from transplantation remain imperfect and novel methods based on the prediction of hepatic regeneration are required. For patients with ALF secondary to acetaminophen overdose, some experts believe a randomized controlled trial is required to find those most likely to benefit from ELT. SUMMARY ALF remains a life-threatening condition with a high mortality rate requiring prompt support of multiorgan failure. Historical listing criteria for ELT are being questioned and improvement in medical management offers the option of continued improvements in transplant-free survival.
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Ginsenosides Rg1 from Panax ginseng: A Potential Therapy for Acute Liver Failure Patients? EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:538059. [PMID: 25431611 PMCID: PMC4241314 DOI: 10.1155/2014/538059] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/09/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
Abstract
Acute liver failure (ALF) is a rapidly progressing critical illness with a high mortality rate. Circulating inflammatory cytokines, such as tumor necrosis factor-α (TNF-α), play a significant role in the pathophysiology of ALF through promoting hepatocellular apoptosis. Ginsenoside Rg1, the primary active ingredient in Panax ginseng (also termed Asian or Korean ginseng), has been reported to inhibit TNF-α production and has been shown to significantly attenuate liver fibrosis development. Here, we assessed ginsenoside Rg1's potential as a therapy for ALF by investigating the effect of ginsenoside Rg1 treatment on circulating inflammatory markers, hepatocellular apoptosis, and relevant apoptotic signaling pathways in a well-established murine ALF model. We found that ginsenoside Rg1 significantly reduces liver damage in a murine ALF model through inhibiting TNF-α-induced, caspase-dependent hepatocellular apoptosis. These results support the further investigation of ginsenoside Rg1 as a therapeutic candidate for ALF.
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Bernsmeier C, Antoniades CG, Wendon J. What's new in acute liver failure? Intensive Care Med 2014; 40:1545-8. [PMID: 24981954 DOI: 10.1007/s00134-014-3350-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/20/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Christine Bernsmeier
- Liver Intensive Therapy Unit, Institute of Liver Studies, King's College London, Denmark Hill Campus, London, UK
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Maiwall R, Maras JS, Nayak SL, Sarin SK. Liver dialysis in acute-on-chronic liver failure: current and future perspectives. Hepatol Int 2014. [PMID: 26201332 DOI: 10.1007/s12072-014-9534-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Patients with acute-on-chronic liver failure (ACLF) are known to have a very high mortality rate as the majority of these patients succumb to multiorgan failure. Liver transplant remains the only option for these patients; however, there are problems with its availability, cost and also the complications and side effects associated with immunosuppression. Unlike advanced decompensated liver disease, there is a potential for hepatic regeneration and recovery in patients with ACLF. A liver support system, cell or non-cell based, logically is likely to provide temporary functional support until the donor liver becomes available or the failing liver survives the onslaught of the acute insult and spontaneously regenerates. Understanding the pathogenesis of liver failure and regeneration is essential to define the needs for a support system. Removal of hepatotoxic metabolites and inhibitors of hepatic regeneration by liver dialysis, a non-cell-based hepatic support, could help to provide a suitable microenvironment and support the failing liver. The current systems, i.e., MARS and Prometheus, have failed to show survival benefits in patients with ACLF based on which newer devices with improved functionality are currently under development. However, larger randomized trials are needed to prove whether these devices can enable restoration of the complex dysregulated immune system and impact organ failure and mortality in these patients.
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Affiliation(s)
- Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India
| | - Jaswinder Singh Maras
- Department of Research, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India
| | - Suman Lata Nayak
- Department of Nephrology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), D1, Vasantkunj, New Delhi, 110070, India.
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