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Liver and hepatology

Hepatology-related clinical indications

Liver indications

The use of therapeutic apheresis techniques in liver support therapy is essential to eliminate non-soluble toxins from the bloodstream. When used in addition to dialysis procedures that remove soluble pathogens, the patient’s needs can be comprehensively met.

There are two main categories of liver failure: acute and acute-on-chronic. Acute liver failure is a syndrome in which patients without pre-existing liver disease sustain an acute liver injury and rapid loss of hepatic function. In contrast, acute-on-chronic liver failure is defined as an acute deterioration of liver function in patients known to have underlying compensated chronic liver disease or stable, compensated cirrhosis.1

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1. Rademacher S, Oppert M et al. Artificial extracorporeal liver support therapy in patients with severe liver failure. Expert Review of Gastroenterology & Hepatology 2011; 5(5): 591–99.
2. Grodzicki M, Kotulski M et al. Results of treatment of acute liver failure patients with the use of the Prometheus FPSA System. Transplantation Proceedings 2009; 41: 3079–81.
3. Evenepoel P, Laleman W et al. Prometheus versus Molecular Adsorbents Recirculating System: Comparison of efficiency in two different liver detoxification devices. Artificial Organs 2006; 30(4): 276–84.
4. Arroyo V et al. Management of hepatorenal syndrome in patients with cirrhosis. Nature Review, Nephrology 7:517-526, 2011.
5. Kribben A et al. Effects of Fractionated Plasma Separation and Adsorption on Survival in Patients with Acute-On-Chronic Liver Failure. Gastroenterology 142 (4):782-789, 2012.
6. Rifai K. Prometheus - a new extracorporeal system for the treatnment of liver failure. In: Hepatic encephalopaty and nitrogen metabolism, edited by D Häusinger, et al. Berlin:Springer, 2006, p. 532-538.
7. Jung O et al. Long-Term Bridging of Acute on Chronic Liver Failure to Successful transplantation with an Extracorporeal Liver Support System. Zeitschrift für Gastroenterologie 45:21-24, 2007.
8. Rifai K et al. Treatment of severe refractory pruritus with fractionated plasma separation and adsorption (Prometheus®). Scandinavian Journal of Gastroenterology 41:1212-1217, 2006.
9. Ołdakowska-Jedynak U, et al. Treatment of pruritus with Prometheus dialysis and absorption system in a patient with benign recurrent intrahepatic cholestasis. Hepatology Research 44 (10):E304-E308, 2014.
10. Aagaard N K et al. A 15 Year-Old Girl with Severe Hemolytic Wilson's Crisis Recovered without Transplantation after Circulation with the Prometheus System. Blood Purification 28:102-107, 2009.