- Email: [email protected]
237 FATTY ACID DEPLETED ALBUMIN CAN IMPROVE EFFECT OF ALBUMIN DIALYSIS IN LIVER SUPPORT
01B. LIVER TRANSPLANTATION/SURGERY/ACUTE LIVER FAILURE – B) CLINICAL clinical profile & complications, between the two groups were compared. Pregnancy outcomes & mortality rates were analyzed. Results: Viral hepatitis (75%) was the leading cause of ALF. HEV infection (60%) was common etiology in pregnant while no such predilection was seen in non pregnant patients. Ecclampsia, drugs, and acute fatty liver of pregnancy were rare. Most patients had ALF onset in III trimester (65%). Pregnant patients had more hyperacute presentation (74% vs 40%) and severe encephalopathy (83% vs. 50%). Pregnant patients had significantly higher alkaline phosphatase, and lower serum proteins, blood glucose, serum calcium and more deranged renal parameters (p < 0.05). Complications like cerebral edema (45%), renal failure (32%) and hemorrhage (31%) were significantly more in pregnant group. Mortality was comparable in pregnant (60%) and non pregnant (56%) patients. In HEV infected pregnant patients, significantly higher fetal loss was seen in nonsurvivors as compared to survivors while no such association was seen in other etiogical groups. Fetal outcome was poor with fetal loss (63%), prematurity (46%) and neonatal asphyxia (30%). Conclusion: Hepatotropic viral infections are leading cause of ALF in our region. ALF is more likely to occur in late pregnancy with more severe complications. Fetal survival is extremely poor in pregnant ALF especially in nonsurvivor patients affected by Hepatitis E.
237 FATTY ACID DEPLETED ALBUMIN CAN IMPROVE EFFECT OF ALBUMIN DIALYSIS IN LIVER SUPPORT J. Stange, J. Ludwig, J. Henschel, M. Gloger, H. Hickstein, S. Mitzner, S. Koball, R. Schmidt. Dept. Internal Medicine, University of Rostock, Rostock, Germany E-mail: [email protected] Background: Hepatic Failure (HF) results in an accumulation of Middle Chain Fatty Acids (MCFA) which induce expression of pro-inflammatory cytokines, vasodilation, hepatic encephalopathy and cerebral edema. Commercial albumin solutions contain very high amounts of MCFA (>5mol/mol albumin), which leads to an accumulation of MCFA if single pass albumin dialysis (SPAD) utilizing up to 640g of commercial albumin is applied in Hepatic Failure (J HEPATOL 44: S69-S69 164 Suppl. 2 2006).
S97
90 and 180 minutes. MCFA were detected by Gas Chromatography. In addition, the course of mean arterial pressure and noradrenaline dosage was documented. Results: Only the use of MCFA depleted Albumin could prevent accumulation of MCFA within the first 3 hours of liver support therapy (see graph). Hemodynamic improvement was seen during MARS but was associated by discontinuation of noradrenalin only during Albumin Dialysis utilizing MCFA depleted albumin (CHANCE-LS). Conclusion: The fact that MCFA free albumin dialysis was paralleled by the most significant hemodynamic improvement supports the hypothesis that MCFA may play a role in vasodilation and MCFA free albumin should undergo clinical evaluation in controlled studies. 238 IMMEDIATE DIAGNOSIS OF PRIMARY NON FUNCTION (PNF) AFTER LIVER TRANSPLANTATION (LTX) BY THE NEW LIMAX-TEST M. Stockmann1 , J. Lock1 , E. Schwabauer1 , N. Videv1 , S. Niehues2 , P. Neuhaus1 . 1 Department of General, Visceral, and Transplantation Surgery, 2 Department of Radiology, Charite, Berlin, Germany E-mail: [email protected] Introduction: Monitoring of liver function is essential after LTX. No liver function test could provide clinically valid and useful results until now. We present a new method which allows the valid measurement of quantitative liver function capacity as a bedside test and investigate the predictive value after LTX. Methods: After intravenous bolus injection of 13C-methacetin (2 mg/kg BW) 13CO2 will be determined in breath online over 60 min by nondispersive isotope-selective infrared spectroscopy. The only rate-limiting step in the reaction is the demethylation of 13C-methacetin by CYP1A2. The new attempt of kinetic analysis when providing saturation kinetics (at least for a short time) allows calculation of maximal liver function capacity. Evaluation of the test was done on 18 patients without cirrhosis directly before and on day 1 after liver resection of different extent. In parallel CT-volumetry of the liver before operation and volumetry of the resected liver was done. Until now 64 patients were followed before and 28 days after deceased liver transplantation. Results: Remnant liver volume and appropriate remnant liver function in the LiMAx-test after liver resection showed a highly significant linear correlation (r = 0.931, p < 0.0001). Already 6 hours after reperfusion patients with primary non function (PNF), with complications and without complications could be discriminated from each other by the LiMAx-test (p < 0.05). PNF could be diagnosed earlier than clinically realized. Discussion: In every clinical situation determination of actual maximal enzymatic liver function capacity by the LiMAx-test was possible. PNF and patients with a complicated postoperative course could be identified immediately after transplantation which allows improved management. 239 POSTOPERATIVE OUTCOME AFTER HEPATECTOMY CAN BE PREDICTED USING A NEW BEDSIDE TEST FOR MAXIMAL LIVER FUNCTION CAPACITY
Middle chain fatty acids in various liver support theories. Aim: To compare the effect of SPAD on MCFA with alternative liver support therapies. Study Design: 6 courses of SPAD, 5 MARS-Therapies and 6 courses of Albumin Dialysis utilizing MCFA depleted Albumin (Clean HepAlbiN Continuous Extracorpreal-CHANCE-Liver Support) were compared. Blood Samples were taken at baseline and after 30,
M. Stockmann1 , J. Lock1 , B. Riecke1 , K. Heyne2 , P. Martus3 , M. Fricke1 , S. Lehmann1 , S. Niehues4 , M. Schwabe5 , A.J. Lemke4 , P. Neuhaus1 . 1 Department of General, Visceral, and Transplantation Surgery, Charite, Berlin, Germany; 2 Institute of Experimental Physics, Free University, Berlin, Germany; 3 Institute for Biostatistics and Clinical Epidemiology, 4 Department of Radiology, 5 Department of Pathology, Charite, Berlin, Germany E-mail: [email protected] Introduction: Liver resection is performed frequently to cure hepatic malignancies. Until now, liver failure is a main cause of mortality especially after major resections. We investigated the predictive factors
237 FATTY ACID DEPLETED ALBUMIN CAN IMPROVE EFFECT OF ALBUMIN DIALYSIS IN LIVER SUPPORT J. Stange, J. Ludwig, J. Henschel, M. Gloger, H. Hickstein, S. Mitzner, S. Koball, R. Schmidt. Dept. Internal Medicine, University of Rostock, Rostock, Germany E-mail: [email protected] Background: Hepatic Failure (HF) results in an accumulation of Middle Chain Fatty Acids (MCFA) which induce expression of pro-inflammatory cytokines, vasodilation, hepatic encephalopathy and cerebral edema. Commercial albumin solutions contain very high amounts of MCFA (>5mol/mol albumin), which leads to an accumulation of MCFA if single pass albumin dialysis (SPAD) utilizing up to 640g of commercial albumin is applied in Hepatic Failure (J HEPATOL 44: S69-S69 164 Suppl. 2 2006).
S97
90 and 180 minutes. MCFA were detected by Gas Chromatography. In addition, the course of mean arterial pressure and noradrenaline dosage was documented. Results: Only the use of MCFA depleted Albumin could prevent accumulation of MCFA within the first 3 hours of liver support therapy (see graph). Hemodynamic improvement was seen during MARS but was associated by discontinuation of noradrenalin only during Albumin Dialysis utilizing MCFA depleted albumin (CHANCE-LS). Conclusion: The fact that MCFA free albumin dialysis was paralleled by the most significant hemodynamic improvement supports the hypothesis that MCFA may play a role in vasodilation and MCFA free albumin should undergo clinical evaluation in controlled studies. 238 IMMEDIATE DIAGNOSIS OF PRIMARY NON FUNCTION (PNF) AFTER LIVER TRANSPLANTATION (LTX) BY THE NEW LIMAX-TEST M. Stockmann1 , J. Lock1 , E. Schwabauer1 , N. Videv1 , S. Niehues2 , P. Neuhaus1 . 1 Department of General, Visceral, and Transplantation Surgery, 2 Department of Radiology, Charite, Berlin, Germany E-mail: [email protected] Introduction: Monitoring of liver function is essential after LTX. No liver function test could provide clinically valid and useful results until now. We present a new method which allows the valid measurement of quantitative liver function capacity as a bedside test and investigate the predictive value after LTX. Methods: After intravenous bolus injection of 13C-methacetin (2 mg/kg BW) 13CO2 will be determined in breath online over 60 min by nondispersive isotope-selective infrared spectroscopy. The only rate-limiting step in the reaction is the demethylation of 13C-methacetin by CYP1A2. The new attempt of kinetic analysis when providing saturation kinetics (at least for a short time) allows calculation of maximal liver function capacity. Evaluation of the test was done on 18 patients without cirrhosis directly before and on day 1 after liver resection of different extent. In parallel CT-volumetry of the liver before operation and volumetry of the resected liver was done. Until now 64 patients were followed before and 28 days after deceased liver transplantation. Results: Remnant liver volume and appropriate remnant liver function in the LiMAx-test after liver resection showed a highly significant linear correlation (r = 0.931, p < 0.0001). Already 6 hours after reperfusion patients with primary non function (PNF), with complications and without complications could be discriminated from each other by the LiMAx-test (p < 0.05). PNF could be diagnosed earlier than clinically realized. Discussion: In every clinical situation determination of actual maximal enzymatic liver function capacity by the LiMAx-test was possible. PNF and patients with a complicated postoperative course could be identified immediately after transplantation which allows improved management. 239 POSTOPERATIVE OUTCOME AFTER HEPATECTOMY CAN BE PREDICTED USING A NEW BEDSIDE TEST FOR MAXIMAL LIVER FUNCTION CAPACITY
Middle chain fatty acids in various liver support theories. Aim: To compare the effect of SPAD on MCFA with alternative liver support therapies. Study Design: 6 courses of SPAD, 5 MARS-Therapies and 6 courses of Albumin Dialysis utilizing MCFA depleted Albumin (Clean HepAlbiN Continuous Extracorpreal-CHANCE-Liver Support) were compared. Blood Samples were taken at baseline and after 30,
M. Stockmann1 , J. Lock1 , B. Riecke1 , K. Heyne2 , P. Martus3 , M. Fricke1 , S. Lehmann1 , S. Niehues4 , M. Schwabe5 , A.J. Lemke4 , P. Neuhaus1 . 1 Department of General, Visceral, and Transplantation Surgery, Charite, Berlin, Germany; 2 Institute of Experimental Physics, Free University, Berlin, Germany; 3 Institute for Biostatistics and Clinical Epidemiology, 4 Department of Radiology, 5 Department of Pathology, Charite, Berlin, Germany E-mail: [email protected] Introduction: Liver resection is performed frequently to cure hepatic malignancies. Until now, liver failure is a main cause of mortality especially after major resections. We investigated the predictive factors