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Cerebral blood flow velocity increases during a single treatment with the molecular adsorbents recirculating system in patients with acute on chronic liver failure
Author(s) -
Schmidt Lars E.,
Svendsen Lars Bo,
Sørensen Vibeke Rømming,
Hansen Bent Adel,
Larsen Fin Stolze
Publication year - 2001
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2001.26059
Subject(s) - medicine , hepatic encephalopathy , cerebral blood flow , bilirubin , perfusion , gastroenterology , mars exploration program , encephalopathy , middle cerebral artery , ischemia , cirrhosis , physics , astronomy
The aim of this uncontrolled pilot study is to determine the effect of treatment with the molecular adsorbents recirculating system (MARS) on cerebral perfusion in patients with acute on chronic liver failure (AOCLF). In 8 patients (median age, 44 years; range, 35 to 52 years) admitted with AOCLF, a single 10‐hour MARS treatment was performed. Hepatic encephalopathy (HE) was graded according to the Fogarty criteria. Changes in cerebral perfusion were determined by transcranial Doppler as mean flow velocity (V mean ) in the middle cerebral artery. Arterial ammonia and bilirubin levels were monitored as a measure of the capability of the MARS to remove water‐soluble and protein‐bound toxins. During MARS treatment, HE grade improved in 3 patients and remained unchanged in 5 patients ( P = .11). V mean increased from 42 cm/sec (range, 26 to 59 cm/sec) to 72 cm/sec (range, 52 to 106 cm/sec; P < .05), whereas arterial ammonia level decreased from 88 μmol/L (range, 45 to 117 μmol/L) to 71 μmol/L (range, 26 to 98 μmol/L; P < .05) and bilirubin level from 537 μmol/L (range, 324 to 877 μmol/L) to 351 μmol/L (range, 228 to 512 μmol/L; P < .05). In conclusion, cerebral perfusion is increased and levels of ammonia and bilirubin are reduced during MARS treatment in patients with AOCLF.