Editorial

As liver failure in its different forms goes on to be a therapeutic challenge at the beginning of the new millenium valuable contributions to the problem are highly welcome. Temporary liver support supplied by extracorporeal liver assist systems on the basis of membrane separation and adsorption techniques on the one hand and biological components as binding protein solutions and hepatocytes on the other hand have been tested both in animal experiments as well as clinically. Among the cell-free liver support systems, the albumin dialysis MARS (Molecular Adsorbent Recirculating System) represents a safe and easy to perform method for the effective removal of watersoluble as well as strongly albumin-bound substances from patients blood.

The system employs human serum albumin in a close loop-circuit, that is separated from the blood by a membrane and contains two sorbent columns. The albumin serves as a toxin carrier from the membrane to the sorbents (Stange J et al. Internat J Artif Organs 1996 : 19; 677). More than 500 patients have been treated since the method was firstly used in man in 1993. Indications treated include acute on chronic hepatic failure in viral and alcoholic liver disease, acute hepatic failure due to viral hepatitis, drug overdose/reactions, Wilson’s disease and others. Moreover, primary non/poor function after liver transplantation and after major liver resection were treated.

Eight pilot trials and two controlled trials could be successfully finished by now. A significant reduction (p < 0.05) in albumin-bound metabolites from patients blood was found for all bilirubin fractions (total, direct, indirect), bile acids, aromatic amino acids, tryptophan, benzodiazepines as well as for creatinine, urea, ammonia, and lactate. Clinical effects observed include significant improvement in hepatic encephalopathy, increase in cerebral blood flow, systemic vascular resistance, mean arterial pressure. Liver function normalized (increase in prothrombin activity (Quick), albumin, antithrombin III, factor VII, decrease in Child-Turcotte-Pugh-score). Kidney function improved even in end stage- hepatorenal syndrome. Significant improvement of survival in comparison to standard medical treatment could be demonstrated in the two randomized clinical trials (hepatorenal syndrome and cholestasis) (Mitzner et al. Liver Transplantation 2000: 6; 277). The system proved to be safe even in critically ill patients.

From the 8.-10. September 2000 the Second International Symposium on Albumin Dialysis in Liver Disease took place in Rostock, Germany. Nineteen groups from ten different countries presented their results with the new technique to an international audience of hepatologists, nephrologists, liver transplant surgeons and intensive care specialists. The meeting consisted of state-of-the-art lectures dealing with the question „Is it worth removing albumin-bound substances?”, single center experiences reporting data from pilot studies, case reports, and a basic and preclinical research session (see program at the end of this book). A wide variety of trials covering chronic as well as acute types of liver failure with promissing results were presented. For all those interested in the subject who were unable to attend the meeting this abstract book was printed. It contains 33 contributions from the Symposium, the program of the Symposium and the first announcement of the 3^rd. International Symposium on Albumin Dialysis to be held from September 7.-9. 2001, again in Rostock, Germany.

We hope, that this supplement issue can convey in part the enthusiastic spirit of the Symposium and will further stimulate the research in the field of extracorporeal liver support.