Prometheus Therapy for the Treatment of Acute Liver Failure in Patients after Cardiac Surgery

Ekaterina Komardina, Michael Yaroustovsky, Marina Abramyan, Marina Plyushch

A.N.Bakulev National Medical Research Center for Cardiovascular Surgery of the Ministry of Health of RF, Moscow, Russia

Date, time and location: 2018.05.26 13:30, Press Hall, 2F

Abstract

Introduction: Acute liver failure is one of the component of multiple organ dysfunction syndrome in patients after cardiac surgery, which significantly increases the mortality in this group.

Aim: To assess the safety and efficacy of extracorporeal liver support Prometheus therapy (fractionated plasma separation asorbtion) in patients with acute liver failure after cardiac surgery.

Material and methods: We studied 39 adult patients with acute liver failure as one of postoperative complications and  treated with Prometheus therapy. Inclusion criteria and criteria to start Prometheus therapies were: serum bilirubin above 180 μmol/l (reference values: 3–17 μmol/l), hepatocyte cytolysis syndrome (at least 2-fold increase in aspartate aminotranspherase and alanine aminotranspherase concentrations; reference values 10–40 U/l) and decrease in plasma cholinesterase (reference values 4490–13 320 U/l). At the moment of inclusion multiple organ dysfunction syndrome was verified in all patients, 82% of them also had acute kidney injury and received renal replacement therapy.

Results: Extracorporeal therapy provided stabilization of hemodynamics, decrease in serum total bilirubin and unconjugated bilirubin levels, decrease in cytolysis syndrome severity and positive effect on the synthetic function of the liver. In our group there were no significant negative dynamics of serous albumin, which is very important in cases of baseline dysproteinemia in acute liver failure. There were no cases of pyrogenic or allergic reactions, hemorrhagic complications or extracorporeal circuit clotting. The 28-day survival rate in the group treated with Prometheus therapy was 23%.

Conclusions: Prometheus procedures could be included in combined intensive care in patients with acute liver failure after cardiac and major vessel surgery. The efficiency of this method could be improved by a multi-factor evaluation of patient condition in order to determine indications for its use.