ABSTRACT
BACKGROUND/AIMS: The molecular adsorbent recirculating system (MARS(R)) is a form of artificial extracorporeal liver support and can be used for a bridge to spontaneous recovery of hepatic function or liver transplantation in patients with liver failure. This study evaluated the usefulness of MARS(R) in patients with liver failure. METHODS: Between January 2004 and July 2007, 30 patients (21 males and 7 females; age 48.9+/-12.9 years) with acute or acute-on-chronic liver failure were managed using MARS(R). We assessed laboratory data, the grade of hepatic encephalopathy, Child-Turcotte-Pugh class, and Model for End-Stage Liver Disease (MELD) score. RESULTS: The number of patients with acute liver failure and acute-on-chronic liver failure was 16 and 14, respectively. The mean cycle of MARS(R) in patients with liver failure was 2.2 sessions. After MARS(R) had been performed, serum total bilirubin, alanine aminotransferase (ALT), BUN, creatinine, ammonia level, daily urine output, and MELD score were improved (p<0.05). In contrast, MARS(R) failed to improve Child-Turcotte-Pugh score and the grade of hepatic encephalopathy. Liver transplantation was performed in 8 patients. Among them, 5 (62.5%) patients survived and 3 (37.5%) patients died. Twenty two patients underwent MARS(R) without liver transplantation and 4 (18.2%) of them survived. CONCLUSIONS: In patients with liver failure, MARS(R) improved the laboratory data and hepatic and renal function associated clinical characteristics. However, MARS(R) without liver transplantation did not improve survival. MARS(R) may be useful as a bridge therapy to liver transplantation in patients with liver failure.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Clinical Chemistry Tests , Combined Modality Therapy , Hepatic Encephalopathy , Liver Failure/mortality , Liver Transplantation , Retrospective Studies , Severity of Illness Index , Sorption Detoxification/methodsABSTRACT
Spores of Cladosporium sp. were immobilized into Ca-alginate beads via entrapment. The alginate beads and both entrapped live and inactivated spores of Cladosporium sp. were used for comparison of biosorptive capacity from aqueous solutions. The factors affecting the adsorption ability on Cu (II), such as the contact time, initial pH, temperature were investigated. The results showed that the Ca-alginate beads containing live spores of Cladosporium sp. had the maximum biosorptive capacity. The biosorption equilibrium was established in about 3 h. The maximum biosorption of Cu (II) on Ca-alginate entrapping spores and no spores were obtained between pH 4.0 and 3.5. Temperature over the range of 15-45 degrees C had no significant effect on the biosorption capacity. The biosorptive capacity increased with initial concentrations in the concentration range of 30-800mg/l. The equilibrium was well described by Langmuir biosorption isotherms. The Ca-alginate beads could be regenerated using 0.1M HCl, The biosorbents were reused in three biosorption-desorption cycles with negligible decrease in biosorptive capacity.