Die theoretische Rationale für die Kombination aus Albumindialyse und einer klassischen Hämodialyse bei akutem (ALF) und akut-auf-chronischem Leberversagen (ACLF) ist gut verständlich. Dennoch konnte bisher nur für den therapeutischen Plasmaaustausch (TPE) ein Überlebensvorteil beim ALF nachgewiesen werden. Dieser Beitrag stellt das Prinzip der Albumindialyse und des TPE sowie die wichtigsten Studien zu diesen Verfahren bei ALF und ACLF dar.
Abstract
Combining albumin dialysis for the removal of hydrophobic substances with classical haemodialysis in the treatment of acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) has a strong theoretical rational and clinical data showed a positive effect on laboratory and partly clinical characteristics of ALF and ACLF. However, neither the MARS nor the Prometheus System has so far been able to demonstrate a mortality benefit in ALF or ACLF patients. To date, only the use of therapeutic plasma exchange (TPE) has demonstrated significant removal of pathogen-associated (PAMPs), damage-associated molecular patterns (DAMPs) and pro-inflammatory cytokines. In addition, TPE also acts simultaneously by replacing protective but depleted mediators, thus improving multiple key pathophysiological principles of both ALF and ACLF. In ALF, both high-volume and standard-volume TPE showed a significant improvement in survival. The data on the use of TPE in ACLF is still sparse, with
only two Chinese monocentric studies in patients with exclusively hepatitis B-associated ACLF suggesting potentially improved survival with TPE. The currently recruiting APACHE study will include patients with the modern EASL-CLIF definition of ACLF.
Schlüsselwörter akutes Leberversagen - akut-chronisches Leberversagen - extrakorporale Therapie - Albumindialyse - therapeutischer Plasmaaustausch
Keywords acute liver failure - acute-on-chronic failure - extracorporeal therapy - Albumin dialysis - therapeutic plasma exchange
