Reports Liver

Application of Hemoadsorption in a Case of Liver Cirrhosis and Alcohol-Related Steatohepatitis with Preexisting Hepatitis C Infection.

Buttner S, Patyna S, Koch B, Finkelmeier F, Geiger H, Sarrazin C, Farnik H.
Blood Purif 2017; 44(1): 30-31

This is the first case study that confirms the successful direct removal of liver toxins...

This is the first case study that confirms the successful direct removal of liver toxins, including ammonia and bile acids by the CytoSorb. In this report a 36-year-old patient with chronic viral hepatitis C and long term chronic alcohol abuse was admitted to ICU with decompensated ethanol toxic liver cirrhosis. Despite an initial attempt to stabilize the patient using an albumin infusion and multiple paracenteses the patient developed hepatorenal syndrome and subsequent dialysis dependency. During this time, an evaluation as to whether the patient could be listed for a liver transplantation was rejected.  As a „last resort“ therapy, CytoSorb treatment was initiated with the rationale to remove inflammation-triggering factors and liver toxins (bile acids, bilirubin, ammonia) in the context of his systemic inflammatory condition as well as his acute-on-chronic liver failure. In total two treatments with CytoSorb were carried out for 6 hours each with a treatment pause of 5 days between adsorbers due to non-existent evidence of use in this kind of patient. Pre and post adsorber measurements during the second treatment confirmed efficient removal of ammonia, bilirubin and bile acids. After initially recovering well with planned discharge to his home environment, the patient subsequently developed a nosocomial pneumonia, after which the patient went into another episode of fulminant pneumogenic sepsis and died three weeks after the last CytoSorb treatment. In this case report, the treatment with combination of CRRT and hemoadsorption using CytoSorb worked extremely well and effectively as a liver support. As a consequence, hepatic encephalopathy improved significantly due to efficient removal of liver toxins including ammonia.

First report of cytokine removal using CytoSorb® in severe noninfectious inflammatory syndrome after liver transplantation

Tomescu DR, Dima SO, Ungureanu D, Popescu M, Tulbure D, Popescu I
Int J Artif Organs 2016

In this report the authors present the case of a 46-year-old man with primary graft...

In this report the authors present the case of a 46-year-old man with primary graft nonfunction after liver transplantation who underwent emergency retransplantation with an ABO-incompatible graft. A severe inflammatory response syndrome (SIRS) was noted in the perioperioperative period of retransplantation. The patient was successfully treated for this condition with CytoSorb in combination with CVVH throughout the intraoperative and early postoperative period.
During and after each treatment a significant and rapid decrease of pro- and anti-inflammatory cytokines was observed (IL-6, IL-10, MCP-1). Reduction of cytokines was associated with normalization of cardiac output, systemic vascular resistance, and improved liver function.
The authors believe this is the first case in which hemoadsorptionin combination with CVVH has been used to manage SIRS in a patient with primary graft nonfunction undergoing emergency retransplantation.

First description of SPAD combined with cytokine adsorption in fulminant liver failure and hemophagocytic syndrome due to generalized HSV-1 infection.

Frimmel S, Schipper J, Henschel J, Yu TT, Mitzner SR, Koball S.
Liver Transpl. 2014 Dec;20(12):1523-4

This case study reports on a 50-year-old immunocompetent woman who was admitted to hospital for...

This case study reports on a 50-year-old immunocompetent woman who was admitted to hospital for acute hepatitis with acute liver failure. After transfer to ICU the patient rapidly developed MOF and was listed for highly urgent liver transplantation. Since existing liver support techniques (MARS treatment) for bridging while awaiting for liver transplantation had no effect, SPAD in combination with CytoSorb was applied resulting in a marked decrease of IL-6, bilirubin as well as a reduction of vasopressor need. Orthotopic liver transplantation could be successfully performed on the 4th day on ICU. CytoSorb treatment was safe and well-tolerated, without any adverse events occurring. Therefore, CytoSorb seems to be promising and new approach for patients with liver failure.