Comparison of the Molecular Adsorbent Recirculating System and Plasmapheresis for Patients With Graft Dysfunction After Liver Transplantation
Comparison of the Molecular Adsorbent Recirculating System and Plasmapheresis for Patients With Graft Dysfunction After Liver Transplantation
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DOI：
10.1016/j.transproceed.2010.04.070
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发表时间：
2010-09-01
影响因子：
0.9
通讯作者：
Lee, S. G.
中科院分区：
文献类型：
--
作者：
Lee, J. Y.;Kim, S. B.;Lee, S. G.
背景肝移植术后移植物功能障碍是一种危及生命的疾病.分子吸附再循环系统（MARS）或血浆置换（PLP）可能是不能接受再次移植的患者移植物功能障碍的有效支持治疗。本研究的目的是比较MARS和PLP在OLT后移植物功能障碍患者中的作用。2002年1月至2007年7月，31例发生移植物功能障碍（定义为高胆红素血症（>10 mg/dL），无胆管梗阻和/或肝性脑病）的奥尔特接受者接受了MARS或PLP治疗。比较MARS组和PLP组的生化和血流动力学数据以及生存率。15例患者接受了41次MARS治疗，16例患者接受了105次PLP治疗。在单次MARS治疗后，患者显示肌酐、尿素氮、胆红素和氨显著降低。单次PLP治疗后，患者凝血酶原时间、胆红素、丙氨酸氨基转移酶、碱性磷酸酶和白蛋白均显著改善。治疗完成后，MARS和PLP均显著改善胆红素值。在90天时，总生存率没有差异; MARS组为53%，PLP组为56%。MARS和PLP都是奥尔特后移植物功能障碍的替代支持治疗。
Background. Graft dysfunction after liver transplantation (OLT) is a life- threatening condition. Molecular adsorbent recirculating system (MARS) or plasmapheresis (PLP) may be effective supportive therapy of graft dysfunction for patients who cannot undergo retransplantation. The aim of this study was to compare the effects of MARS and PLP in patients with graft dysfunction after OLT.Methods. Between January 2002 and July 2007, 31 OLT recipients who experienced graft dysfunction, defined as hyperbilirubinemia (>10 mg/dL) without bile duct obstruction and/or presence of hepatic encephalopathy, were treated with MARS or PLP. Biochemical and hemodynamic data and survival were compared in MARS and PLP groups.Results. Fifteen patients were treated with 41 MARS sessions and 16 with 105 PLP sessions. After a single MARS session, patients showed significant reductions in creatinine, urea nitrogen, bilirubin, and ammonia. After a single PLP session, patients showed significant improvements in prothrombin time, bilirubin, alanine aminotransferase, alkaline phosphatase, and albumin. After the completion of treatment, Both MARS and PLP significantly improved bilirubin values. at 90 days there were no differences in overall survival rates; 53% in MARS versus 56% in PLP.Conclusion. Both MARS and PLP are alternative supportive treatments for graft dysfunction after OLT.