Novelli G, Rossi M, Poli L, Morabito V, Bussotti A, Pugliese F, Ruberto F, Novelli S, Mennini G, Berloco P B
Dipartimento Paride Stefanini Unità di Chirurgia Generale e Trapianti d'Organo, La Sapienza Università di Roma, Rome, Italy.
Transplant Proc. 2008 Jul-Aug;40(6):1854-7. doi: 10.1016/j.transproceed.2008.05.076.
Patients with acute liver failure (ALF) show an aggravated hyperdynamic circulation. We evaluated potential changes in systemic hemodynamics and improved kidney function induced by the molecular adsorbent recirculating system (MARS) in a group of patients with primary nonfunction (PNF).
In the intensive care unit we treated 18 patients with PNF (6 females and 12 males) after orthotopic liver transplantation (OLT) of overall mean age 47.8 years (range, 28-60 years). Continuous MARS treatment was performed on all patients with a kit change every 8 hours during a mean of 10 days (range, 1-20 days). Double-lumen catheter type veno-venous access was used for the blood supply. The blood flow rate was 150 to 250 mL/min, depending on the hemodynamic situation of the patient. Blood passed through an albumin nonpermeable, high flux dialysis membrane. During MARS treatment we monitored the hemodynamic condition, using a series of parameters: heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), and pulmonary vascular resistance index (PVRI) before (baseline value) as well as after 1 hour (T1), 3 hours (T2), and the end of treatment (T3).
There was a progressive decrease in positive inotropic support (dobutamine, norepinephrine) and significant improvement in hemodynamic parameters, such as MAP (P< .01), PVRI/SVRI/V(mean) (P< .002), and KARI (P< .01). The improved kidney functions were shown by significant improvements in serum creatinine (P< .03), urea (P< .02), and urine volume (P< .005). Eleven patients were alive: 6 with OLT and 5 without OLT. Seven patients died: 4 after OLT and 3 before OLT due to multiorgan failure.
The MARS device significantly improved the hemodynamic parameters and kidney function that also determine patient survival in ALF (61.1%) with PNF while awaiting retransplantation presumably by removal of certain vasoactive substances.
急性肝衰竭（ALF）患者表现出高动力循环加重。我们评估了分子吸附再循环系统（MARS）对一组原发性无功能（PNF）患者全身血流动力学的潜在变化以及肾功能的改善情况。
在重症监护病房，我们治疗了18例原位肝移植（OLT）后发生PNF的患者（6例女性和12例男性），总体平均年龄47.8岁（范围28 - 60岁）。对所有患者进行持续MARS治疗，平均10天（范围1 - 20天）期间每8小时更换一次套件。采用双腔导管型静脉 - 静脉通路进行血液供应。根据患者的血流动力学情况，血流速度为150至250 mL/分钟。血液通过白蛋白不可渗透的高通量透析膜。在MARS治疗期间，我们使用一系列参数监测血流动力学状况：治疗前（基线值）以及治疗1小时（T1）、3小时（T2）和治疗结束时（T3）的心率（HR）、平均动脉压（MAP）、心脏指数（CI）、全身血管阻力指数（SVRI）和肺血管阻力指数（PVRI）。
正性肌力支持（多巴酚丁胺、去甲肾上腺素）逐渐减少，血流动力学参数如MAP（P <.01）、PVRI/SVRI/V（平均）（P <.002）和KARI（P <.01）有显著改善。肾功能改善表现为血清肌酐（P <.03）、尿素（P <.02）和尿量（P <.005）显著改善。11例患者存活：6例接受OLT，5例未接受OLT。7例患者死亡：4例在OLT后，3例在OLT前因多器官衰竭死亡。
MARS装置显著改善了血流动力学参数和肾功能，这些参数也决定了等待再次移植的PNF型ALF患者（61.1%）的生存情况，可能是通过清除某些血管活性物质实现的。
