The use of therapeutic apheresis techniques in liver support therapy is essential to eliminate non-soluble toxins from the bloodstream. When used in addition to dialysis procedures that remove soluble pathogens, the patient’s needs can be comprehensively met.
There are two main categories of liver failure: acute and acute-on-chronic. Acute liver failure is a syndrome in which patients without pre-existing liver disease sustain an acute liver injury and rapid loss of hepatic function. In contrast, acute-on-chronic liver failure is defined as an acute deterioration of liver function in patients known to have underlying compensated chronic liver disease or stable, compensated cirrhosis.1
Major causes of acute liver failure are infections (mainly acute viral hepatitis), toxins or drugs (especially acetaminophen); further causes are cardiovascular failure and metabolic disorders.1
Prometheus® liver support therapy is used for various indications in acute and acute-on-chronic liver failure as a bridge for patients to transplantation or the recovery of their liver function.2,3
Patients with liver cirrhosis develop progressive circulatory dysfunction that may results in renal fluid retention, ascites and dilutional hyponatremia and will finally lead to hepatorenal syndrome (HRS).
HRS type II is characterized by slowly progressive renal failure and refractory ascites, whereas HRS type I is an acute condition characterized by rapidly progressive, functional, renal failure. HRS type I is usually triggered by a precipitating event, and associated with multiorgan and multisystem failure.4,5
Acute hepatic encephalopathy is a neuropsychiatric syndrome that is frequently associated with fulminant hepatitis. Severe liver failure can cause the patient’s blood to become overloaded with toxins. The majority of these toxic substances are bound to albumin. They are known to play a key role in the pathophysiology of important complications of liver failure e.g. hepatic encephalopathy.6,7
Pruritus is a complication of cholestasis that may be a symptom of a variety of liver diseases. Cholestasis can develop in patients with bile duct obstruction, bile duct rarefication or hepatocellular damage.8,9
In addition to the aforementioned indications, extracorporeal liver support therapy can potentially be used to treat the following diseases: