Sistemas de soporte hepático extracorpóreo | Revista Colombiana de Anestesiología

Información del artículo

RESUMEN

Introducción.

Los sistemas de soporte hepático extracorpóreo (SHE) surgen como una alternativa al trasplante hepático (TH), dado el incremento en la incidencia de falla hepática aguda (FHA), falla hepática crónica agudizada (FHCA), así como las restricciones en la oferta de órganos.

Objetivo.

Revisión de la literatura de los sistemas de soporte hepático extracorporeo.

Metodología.

Búsqueda de la literatura publicada entre julio de 1990 y noviembre de 2010 en las principales bases de datos médicas que incluyeron MEDLINE, SciELO y EMBASE, de artículos que analizaran tecnologías relacionadas con sistemas de soporte hepático en cuanto a sus especificaciones técnicas, sus usos y la evidencia respecto a su efectividad en pacientes con algún tipo de falla hepática que requirieran soporte.

Resultados.

Estos sistemas pueden dividirse en artificiales (hemofiltración, sistema MARS) y bioartificiales (como el Hepatassist™). Su fundamento consiste en reemplazar los procesos de destoxificación relacionados específicamente con el sistema de bilirrubinas, la eliminación de aminoácidos aromáticos, agentes inflamatorios y el manejo de los productos de degradación del sistema de la coagulación. Los recientes avances en bioingeniería y biogenética han hecho que estas tecnologías se acerquen cada vez más a una forma ideal, permitiendo que sean utilizados con relativo éxito en humanos. Los SHE, en su gran mayoría en desarrollo, pretenden no solo actuar como puente al TH, sino que, en casos puntuales, pueden llegar a ser la piedra angular del tratamiento mientras la FHA logra resolverse.

Palabras clave::

Insuficiencia hepática

fallo hepático agudo

hígado artificial

fallo hepático. (Fuente: DeCS, BIREME).

SUMMARY

Background.

Extracorporeal liver support systems (ELS) have emerged as an alternative to liver transplant (LT), given the growing incidence of acute liver failure (ALF), acute-on-chronic liver failure (ACLF) and the limited organ supply.

Objective.

Review of literature about Extracorporeal Liver Support Systems.

Methodology.

A literature search was conducted on the main medical databases including MEDLINE, SciELO and EMBASE for papers published between July 1990 and November 2010 looking at technologies associated with liver support systems, their technical specifications, their use, and evidence regarding their effectiveness in patients with some forms of liver failure requiring support.

Results.

These systems may be divided into artificial (hemofiltration, MARS) and bioartificial (such as the Hepatassist™). They work by replacing detoxification processes associated specifically with bilirubins, aromatic aminoacids, and inflammatory agents, and the elimination of breakdown products of coagulation. Recent advances in bioengineering and biogenetics have brought these technologies closer to the ideal, enabling their use in humans with a relative degree of success. ELS systems, most of them still under development, are designed not only to act as a bridge for LT but may also become the cornerstone of treatment in specific cases while the ALF resolves.

Keywords:

Hepatic insufficiency

liver

artificial

liver failure

acute. (Source: MeSH, NLM).

El Texto completo está disponible en PDF

REFERENCES

[1.]

W.A. Bower, M. Johns, H.S. Margolis, I.T. Williams, B.P. Bell.

Population-based surveillance for acute liver failure.

Am J Gastroenterol, 102 (2007 Nov), pp. 2459-2463

http://dx.doi.org/10.1111/j.1572-0241.2007.01388.x | Medline

[2.]

A. Escorsell, A. Mas, M. De la Mata.

Acute liver failure in Spain: analysis of 267 cases.

Liver Transpl, 13 (2007 Oct), pp. 1389-1395

http://dx.doi.org/10.1002/lt.21119 | Medline

[3.]

W. Bernal, G. Auzinger, A. Dhawan, J. Wendon.

Acute liver failure.

Lancet, 376 (2010 Jul 17), pp. 190-201

http://dx.doi.org/10.1016/S0140-6736(10)60274-7 | Medline

[4.]

F. Sierra.

Acute liver failure: Socratic and hypothetic discussion with the resident.

Rev Col Gastroenterol, 21 (2006 Sep), pp. 182-189

[5.]

W. Bernal, T.J. Cross, G. Auzinger, E. Sizer, M.A. Heneghan, M. Bowles.

Outcome after wait-listing for emergency liver transplantation in acute liver failure: a single centre experience.

J Hepatol, 50 (2009 Feb), pp. 306-313

http://dx.doi.org/10.1016/j.jhep.2008.09.012 | Medline

[6.]

A. Mas, A. Escorsell, J. Fernandez.

Liver transplantation for acute liver failure: a spanish perspective.

Transplant Proc, 42 (2010 Mar), pp. 619-621

http://dx.doi.org/10.1016/j.transproceed.2010.02.005 | Medline

[7.]

G. Atienza Merino.

Evaluation of extracorporeal liver support systems in the treatment of liver failure. A systematic review.

Gastroenterol Hepatol, 33 (2010 May), pp. 352-362

http://dx.doi.org/10.1016/j.gastrohep.2010.01.002 | Medline

[8.]

B. Carpentier, A. Gautier, C. Legallais.

Artificial and bioartificial liver devices: present and future.

Gut, 58 (2009 Dec), pp. 1690-1702

http://dx.doi.org/10.1136/gut.2008.175380 | Medline

[9.]

S. Lafuente, M.J. Bertran, A. Escorsell.

Artificial liver support. Literature review.

Med Clin (Barc), (2010 Apr 21),

[10.]

T.J. McKenzie, J.B. Lillegard, S.L. Nyberg.

Artificial and bioartificial liver support.

Semin Liver Dis, 28 (2008 May), pp. 210-217

http://dx.doi.org/10.1055/s-2008-1073120 | Medline

[11.]

J. Phua, K.H. Lee.

Liver support devices.

Curr Opin Crit Care, 14 (2008 Apr), pp. 208-215

http://dx.doi.org/10.1097/MCC.0b013e3282f70057 | Medline

[12.]

A. Santoro, E. Mancini, E. Ferramosca, S. Faenza.

Liver support systems.

Contrib Nephrol, 156 (2007), pp. 396-404

http://dx.doi.org/10.1159/0000102130 | Medline

[13.]

V. Stadlbauer, R. Jalan.

Acute liver failure: liver support therapies.

Curr Opin Crit Care, 13 (2007 Apr), pp. 215-221

http://dx.doi.org/10.1097/MCC.0b013e328052c4cc | Medline

[14.]

J.T. DiPiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G. Wells, L.M. Posey.

Pharmacoterapy: a pathophysiologic approach.

7 ed,

[15.]

J.O. Clemmesen, F.S. Larsen, J. Kondrup, B.A. Hansen, P. Ott.

Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration.

Hepatology, 29 (1999 Mar), pp. 648-653

http://dx.doi.org/10.1002/hep.510290309 | Medline

[16.]

J.P. Liu, L.L. Gluud, B. Als-Nielsen, C. Gluud.

Artificial and bioartificial support systems for liver failure.

Cochrane Database Syst Rev, (2004),

[17.]

N. Kobayashi.

Life support of artificial liver: development of a bioartificial liver to treat liver failure.

J Hepatobiliary Pancreat Surg, 16 (2009), pp. 113-117

http://dx.doi.org/10.1007/s00534-008-0022-1 | Medline

[18.]

A. Davenport, E.J. Will, A.M. Davison.

Effect of renal replacement therapy on patients with combined acute renal and fulminant hepatic failure.

Kidney Int Suppl, 41 (1993 Jun), pp. S245-S251

Medline

[19.]

M.V. Catalina-Rodríguez, R. Banares-Canizares.

Artificial liver support systems: update on albumin dialysis (MARS).

Gastroenterol Hepatol, 28 (2005 Oct), pp. 453-460

Medline

[20.]

M. Boyle, J. Kurtovic, D. Bihari, S. Riordan, C. Steiner.

Equipment review: the molecular adsorbents recirculating system (MARS).

Crit Care, 8 (2004 Aug), pp. 280-286

http://dx.doi.org/10.1186/cc2895 | Medline

[21.]

H. Isoniemi, A.M. Koivusalo, H. Repo, I. Ilonen, K. Hockerstedt.

The effect of albumin dialysis on cytokine levels in acute liver failure and need for liver transplantation.

Transplant Proc, 37 (2005 Mar), pp. 1088-1090

http://dx.doi.org/10.1016/j.transproceed.2004.11.060 | Medline

[22.]

A. Chiu, S.T. Fan.

MARS in the treatment of liver failure: controversies and evidence.

Int J Artif Organs, 29 (2006 Jul), pp. 660-667

Medline

[23.]

L.M. Guo, J.Y. Liu, D.Z. Xu, B.S. Li, H. Han, L.H. Wang.

Application of Molecular Adsorbents Recirculating System to remove NO and cytokines in severe liver failure patients with multiple organ dysfunction syndrome.

Liver Int, 23 (2003), pp. 16-20

Medline

[24.]

V. Stadlbauer, G.A. Wright, R. Jalan.

Role of artificial liver support in hepatic encephalopathy.

Metab Brain Dis, 24 (2009 Mar), pp. 15-26

http://dx.doi.org/10.1007/s11011-008-9117-2 | Medline

[25.]

I. Ilonen, A.M. Koivusalo, K. Hockerstedt, H. Isoniemi.

Albumin dialysis has no clear effect on cytokine levels in patients with life-threatening liver insufficiency.

Transplant Proc, 38 (2006 Dec), pp. 3540-3543

http://dx.doi.org/10.1016/j.transproceed.2006.10.058 | Medline

[26.]

R. Gaspari, A.W. Avolio, L. Zileri Dal Verme, S. Agnes, R. Proietti, M. Castagneto.

Molecular adsorbent recirculating system in liver transplantation: safety and efficacy.

Transplant Proc, 38 (2006 Dec), pp. 3544-3551

http://dx.doi.org/10.1016/j.transproceed.2006.10.032 | Medline

[27.]

T. Kantola, A.M. Koivusalo, K. Hockerstedt, H. Isoniemi.

The effect of molecular adsorbent recirculating system treatment on survival, native liver recovery, and need for liver transplantation in acute liver failure patients.

Transpl Int, 21 (2008 Sep), pp. 857-866

http://dx.doi.org/10.1111/j.1432-2277.2008.00698.x | Medline

[28.]

H.K. Tan.

Molecular adsorbent recirculating system (MARS).

Ann Acad Med Singapore, 33 (2004 May), pp. 329-335

Medline

[29.]

G.D. Wagholikar, K.H. Lee, D. Pandey, S.O. Leong, R. Singh, K.C. Tan.

Pre-transplant optimization by molecular adsorbent recirculating system in patients with severely decompensated chronic liver disease.

Indian J Gastroenterol, 26 (2007 May-Jun), pp. 110-112

Medline

[30.]

W. Laleman, A. Wilmer, P. Evenepoel, I.V. Elst, M. Zeegers, Z. Zaman.

Effect of the molecular adsorbent recirculating system and Prometheus devices on systemic haemodynamics and vasoactive agents in patients with acute-on-chronic alcoholic liver failure.

Crit Care, 10 (2006), pp. R108

http://dx.doi.org/10.1186/cc4985 | Medline

[31.]

W.K. Lai, G. Haydon, D. Mutimer, N. Murphy.

The effect of molecular adsorbent recirculating system on pathophysiological parameters in patients with acute liver failure.

Intensive Care Med, 31 (2005 Nov), pp. 1544-1549

http://dx.doi.org/10.1007/s00134-005-2786-y | Medline

[32.]

G. Donati, F. Piscaglia, L. Coli, E. Silvagni, R. Righini, P. Pini.

Acute systemic, splanchnic and renal haemodynamic changes induced by molecular adsorbent recirculating system (MARS) treatment in patients with end-stage cirrhosis.

Aliment Pharmacol Ther, 26 (2007 Sep 1), pp. 717-726

http://dx.doi.org/10.1111/j.1365-2036.2007.03420.x | Medline

[33.]

K.H. Lee, M.K. Lee, D.S. Sutedja, S.G. Lim.

Outcome from molecular adsorbent recycling system (MARS) liver dialysis following drug-induced liver failure.

Liver Int, 25 (2005 Oct), pp. 973-977

http://dx.doi.org/10.1111/j.1478-3231.2005.01091.x | Medline

[34.]

J.L. Montero, J.C. Pozo, P. Barrera, E. Fraga, G. Costan, J.L. Dominguez.

Treatment of refractory cholestatic pruritus with molecular adsorbent recirculating system (MARS).

Transplant Proc, 38 (2006 Oct), pp. 2511-2513

http://dx.doi.org/10.1016/j.transproceed.2006.08.052 | Medline

[35.]

L.E. Schmidt, L.B. Svendsen, V.R. Sorensen, B.A. Hansen, F.S. Larsen.

Cerebral blood flow velocity increases during a single treatment with the molecular adsorbents recirculating system in patients with acute on chronic liver failure.

Liver Transpl, 7 (2001 Aug), pp. 709-712

http://dx.doi.org/10.1053/jlts.2001.26059 | Medline

[36.]

V. Stadlbauer, N.A. Davies, S. Sen, R. Jalan.

Artificial liver support systems in the management of complications of cirrhosis.

Semin Liver Dis, 28 (2008 Feb), pp. 96-109

http://dx.doi.org/10.1055/s-2008-1040324 | Medline

[37.]

C. Camus, S. Lavoue, A. Gacouin, Y. Le Tulzo, R. Lorho, K. Boudjema.

Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation.

Intensive Care Med, 32 (2006 Nov), pp. 1817-1825

http://dx.doi.org/10.1007/s00134-006-0340-1 | Medline

[38.]

A. Chiu, L.M. Chan, S.T. Fan.

Molecular adsorbent recirculating system treatment for patients with liver failure: the Hong Kong experience.

Liver Int, 26 (2006 Aug), pp. 695-702

http://dx.doi.org/10.1111/j.1478-3231.2006.01293.x | Medline

[39.]

E.B. Bachli, R.A. Schuepbach, M. Maggiorini, R. Stocker, B. Mullhaupt, E.L. Renner.

Artificial liver support with the molecular adsorbent recirculating system: activation of coagulation and bleeding complications.

Liver Int, 27 (2007 May), pp. 475-484

http://dx.doi.org/10.1111/j.1478-3231.2006.01398.x | Medline

[40.]

C. Doria, L. Mandala, J.D. Smith, G. Caruana, V.L. Scott, S. Gruttadauria.

Thromboelastography used to assess coagulation during treatment with molecular adsorbent recirculating system.

Clin Transplant, 18 (2004 Aug), pp. 365-371

http://dx.doi.org/10.1111/j.1399-0012.2004.00172.x | Medline

[41.]

H.K. Tan, W.S. Yang, P. Chow, H.F. Lui, H.L. Choong, K.S. Wong.

Anticoagulation minimization is safe and effective in albumin liver dialysis using the molecular adsorbent recirculating system.

Artif Organs, 31 (2007 Mar), pp. 193-199

http://dx.doi.org/10.1111/j.1525-1594.2007.00364.x | Medline

[42.]

P. Faybik, A. Bacher, S.A. Kozek-Langenecker, H. Steltzer, C.G. Krenn, S. Unger.

Molecular adsorbent recirculating system and hemostasis in patients at high risk of bleeding: an observational study.

Crit Care, 10 (2006 Feb), pp. R24

http://dx.doi.org/10.1186/cc3985 | Medline

[43.]

F.P. Hessel.

Economic evaluation of the artificial liver support system MARS in patients with acute-on-chronic liver failure.

Cost Eff Resour Alloc, 4 (2006), pp. 16

http://dx.doi.org/10.1186/1478-7547-4-16 | Medline

[44.]

F.P. Hessel, P. Bramlage, J. Wasem, S.R. Mitzner.

Cost-effectiveness of the artificial liver support system MARS in patients with acute-on-chronic liver failure.

Eur J Gastroenterol Hepatol, 22 (2010 Feb), pp. 213-220

http://dx.doi.org/10.1097/MEG.0b013e3283314e48 | Medline

[45.]

B. Wolff, K. Machill, D. Schumacher, I. Schulzki.

MARS dialysis in decompensated alcoholic liver disease: a single-center experience.

Liver Transpl, 13 (2007 Aug), pp. 1189-1192

http://dx.doi.org/10.1002/lt.21235 | Medline

[46.]

C.T. Wai, S.G. Lim, M.O. Aung, Y.M. Lee, D.S. Sutedja, Y.Y. Dan.

MARS: a futile tool in centres without active liver transplant support.

Liver Int, 27 (2007 Feb), pp. 69-75

http://dx.doi.org/10.1111/j.1478-3231.2006.01388.x | Medline

[47.]

M. Oppert, S. Rademacher, K. Petrasch, A. Jorres.

Extracorporeal liver support therapy with Prometheus in patients with liver failure in the intensive care unit.

Ther Apher Dial, 13 (2009 Oct), pp. 426-430

http://dx.doi.org/10.1111/j.1744-9987.2009.00761.x | Medline

[48.]

A. Saito.

Current progress in blood purification methods used in critical care medicine.

Contrib Nephrol, 166 (2010), pp. 100-111

http://dx.doi.org/10.1159/000314858 | Medline

[49.]

K. Rifai, T. Ernst, U. Kretschmer, H. Haller, M.P. Manns, D. Fliser.

Removal selectivity of Prometheus: a new extracorporeal liver support device.

World J Gastroenterol, 12 (2006 Feb 14), pp. 940-944

Medline

[50.]

P. Evenepoel, W. Laleman, A. Wilmer, K. Claes, D. Kuypers, B. Bammens.

Prometheus versus molecular adsorbents recirculating system: comparison of efficiency in two different liver detoxification devices.

Artif Organs, 30 (2006 Apr), pp. 276-284

http://dx.doi.org/10.1111/j.1525-1594.2006.00215.x | Medline

[51.]

V. Stadlbauer, P. Krisper, R. Aigner, B. Haditsch, A. Jung, C. Lackner.

Effect of extracorporeal liver support by MARS and Prometheus on serum cytokines in acute-on-chronic liver failure.

Crit Care, 10 (2006), pp. R169

http://dx.doi.org/10.1186/cc5119 | Medline

[52.]

J. Meyburg, G.F. Hoffmann.

Liver, liver cell and stem cell transplantation for the treatment of urea cycle defects.

Mol Genet Metab, 100 (2010), pp. S77-S83

http://dx.doi.org/10.1016/j.ymgme.2010.01.011 | Medline

[53.]

L.L. Kjaergard, J. Liu, B. Als-Nielsen, C. Gluud.

Artificial and bioartificial support systems for acute and acute-on-chronic liver failure: a systematic review.

JAMA, 289 (2003 Jan 8), pp. 217-222

Medline

[54.]

K. Onodera, H. Sakata, M. Yonekawa, A. Kawamura.

Artificial liver support at present and in the future.

J Artif Organs, 9 (2006), pp. 17-28

http://dx.doi.org/10.1007/s10047-005-0320-1 | Medline

[55.]

E. Varo Pérez, J.F. Castroagudin.

The future of liver transplantation.

Transplant Proc, 42 (2010 Mar), pp. 613-616

http://dx.doi.org/10.1016/j.transproceed.2010.02.003 | Medline

Indexada en:

Síguenos:

Indexada en:

Síguenos:

Suscríbase a la newsletter