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Krisper, P; Stauber, RE.
Technology insight: artificial extracorporeal liver support--how does Prometheus compare with MARS?
NAT CLIN PRACT NEPHROL. 2007; 3(5): 267-276. Doi: 10.1038/ncpneph0466
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Leading authors Med Uni Graz: Krisper Peter
Co-authors Med Uni Graz: Stauber Rudolf
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Abstract:: Artificial extracorporeal liver support or 'liver dialysis' has been used in patients with severe liver failure with increasing frequency since the Molecular Adsorbents Recirculating System (MARS), a variant of albumin dialysis, was introduced in 1999. Nevertheless, liver dialysis must still be thought of as experimental because its contribution to improved patient survival has not been proven in large randomized trials. Prometheus is a novel device for fractionated plasma separation via an albumin-permeable filter that was developed to improve removal of albumin-bound toxins. Initial studies have proven clinical use of Prometheus to be feasible and safe. Head-to-head comparisons of Prometheus and MARS have shown treatment with the former to be more efficient with respect to removal of most albumin-bound and water-solved markers. As controlled studies with clinical end points are lacking, it is not known whether the observed greater detoxification capacity of Prometheus will translate into clinical benefit; two small studies indicate that there might be a beneficial effect in hepatic encephalopathy and pruritus. In a recent randomized comparison of MARS and Prometheus, however, hemodynamic improvement was observed in response to MARS, but not Prometheus, treatment. A large randomized controlled trial investigating the effect of Prometheus on survival--the HELIOS study--has been initiated. First results are expected in 2008 and will be crucial to establishing a role for Prometheus in the field of extracorporeal liver support.
Find related publications in this database (using NLM MeSH Indexing): Anticoagulants - therapeutic use; Cholestasis - complications; Citric Acid - therapeutic use; Equipment Design - therapeutic use; Heparin - therapeutic use; Humans - therapeutic use; Liver Failure - therapy; Pruritus - etiology; Safety - etiology; Sorption Detoxification - instrumentation
Find related publications in this database (Keywords): albumin; efficiency; fractionated plasma separation; liver failure; safety