Molecular adsorbent recirculating system in patients with early allograft dysfunction after liver transplantation: A pilot study
Molecular adsorbent recirculating system in patients with early allograft dysfunction after liver transplantation: A pilot study
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DOI：
10.1002/lt.20804
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发表时间：
2006-09-01
影响因子：
4.6
通讯作者：
Krenn, Claus Georg
中科院分区：
文献类型：
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作者：
Hetz, Hubert;Faybik, Peter;Krenn, Claus Georg
原位肝移植（OLT）后的早期同种异体移植功能障碍（EAD）导致显着的发病率和死亡率。我们进行了一项前瞻性试点研究，以评估分子吸附再循环系统（MARS）治疗 OLT 后 EAD 的安全性和有效性。前瞻性纳入并接受了 MARS 的支持，连续 12 名成年同种异体肝脏移植受者，其中 9 名是男性，中位年龄为 48 岁。 EAD定义为存在以下至少2种：再灌注后72小时内血清胆红素> 10 mg/dL，凝血酶原时间< 40%，天冬氨酸转氨酶或丙氨酸转移酶> 1,000 U/L，吲哚菁绿血浆消失率（PDR（ICG））< 10%/分钟。患者和移植物的一年存活率为 66%。 MARS治疗后血清胆红素（P = 0.002）、血清肌酐（P = 0.006）和天冬氨酸转氨酶（P = 0.005）显着降低，PDR（ICG）（P = 0.007）显着增加。凝血酶原时间、白蛋白水平和血小板计数保持稳定。观察到肾功能、神经功能以及平均动脉压持续改善。没有发生与 MARS 相关的不良反应。 MARS 治疗为 OLT 后 EAD 的治疗提供了一种安全的方法。在此试点研究的基础上，启动了一项在OLT后使用MARS治疗EAD的多中心随机临床试验。
Early allograft dysfunction (EAD) after orthotopic liver transplantation (OLT) causes marked morbidity and mortality. We conducted a prospective pilot study to assess the safety and efficacy of molecular adsorbent recirculating system (MARS) in treatment of EAD after OLT. Twelve consecutive adult liver allograft recipients with a median age of 48 years, 9 of whom were male, were prospectively included and supported with MARS. EAD was defined as the presence of at least 2 of the following: serum bilirubin > 10 mg/dL, prothrombin time < 40%, aspartate aminotransferase or alanine transferase > 1,000 U/L, and plasma disappearance rate of indocyanine green (PDR(ICG)) < 10% per minute within 72 hours after reperfusion. One-year patient and graft survival was 66%. There was a significant decrease in serum bilirubin (P = 0.002), serum creatinine (P = 0.006), and aspartate aminotransferase (P = 0.005) and a significant increase in PDR(ICG) (P = 0.007) after MARS treatment. Prothrombin time, albumin level, and platelet count remained stable. Sustained improvement of renal and neurological function and of mean arterial pressure were observed. No MARS-related adverse effects occurred. MARS treatment provides a safe approach to the treatment of EAD after OLT. On the basis of this pilot study, a multicenter randomized clinical trial that uses MARS treatment in EAD after OLT has been initiated.