Abstract

Background: The authors present the results of treatment of patients with  acute liver failure with the use of Prometheus FPSA dialysis system.
Material/Methods: Until August 2008 there were performed 248 FPSA procedures in 104 patients. 44 patients were introduced to FPSA treatment due to acute liver failure. Group of patients who underwent FPSA procedure consisted of 27 women / 17 men, with mean age 31±12. Causes of acute liver failure were: Wilson's disease (14), unknown origin ALF (8), amanita phalloides intoxication (7), paracetamol intoxication (6), acute HBV/HCV infection (4), liver insufficiency after parenchymal resection (2), DRESS Syndrome (1), rhabdomyolysis (1), PNF after OLTx (1). All procedures were performed with Prometheus® 4008H Fresenius Medical Care liver support system. Average number of treatments for 1 patient was 2.38 and average time of FPSA treatment was 6.2 h. Average heparin dose used during procedure was 750 i.u/h.
Results: After whole treatment significant improvement of the biochemical
tests results was observed. Average concentration of serum ammonia (before
239.2 ug/dl, after 105.8 ug/dl); bilirubin (before 26.4 mg/dl, after 6.81 mg/dl). Average serum aminotransferase activity AST (before 2156.4 U/L, after 1094.8 U/L); ALT (before 2698.2 U/L, after 1434.8 U/l). Average concentration of serum urea (before 67.6 mg/dl, after 27.1 mg/dl); creatinine (before 2.6 mg/dl, after 1.3 mg/dl). Mean pH value (before 7.19, after 7.36). After Prometheus treatment liver transplantation was performed in 27 patients. 24 patients survived (54.5%); 19 patients FPSA+OLTx, 5 patients without OLTx. 20 patients died (45.4%); 12 before OLTx, and 8 after OLTx.
Conclusions: 1. Usage of FPSA system is a useful method of detoxication in a group of patients with acute liver failure (ALF). 2. Prometheus® 4008H  Fresenius Medical Care liver support system can be considered as an element of liver function support before transplantation.

Keywords: Liver Transplantation, clinical outcome