Molecular adsorbent recirculating system therapy in a rare case of fulminant hepatitis
Author(s)
Vincenzo Morabito*,
Giancarlo Ferretti,
Francesco Pugliese,
Simone Novelli,
Massimo Rossi,
Gilnardo Novelli
Affiliation(s)
Department “P. Stefanini” General Surgery and Organs Transplant, Sapienza University of Rome, Rome, Italy. Department of Infectous Disease, Sapienza University of Rome, Rome, Italy. Department of Aenesthetic Science and Critical Care Medicine, Sapienza University of Rome, Rome, Italy. Department of Clinical Engineering, Sapienza University of Rome, Rome, Italy.
Department “P. Stefanini” General Surgery and Organs Transplant, Sapienza University of Rome, Rome, Italy. Department of Infectous Disease, Sapienza University of Rome, Rome, Italy. Department of Aenesthetic Science and Critical Care Medicine, Sapienza University of Rome, Rome, Italy. Department of Clinical Engineering, Sapienza University of Rome, Rome, Italy.
ABSTRACT
Background: Acute hepatitis C virus infection leading to fulminant hepatitis is very rare whereas Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. The repertoire of substances that accumulate in the blood in fulminant hepatic failure cause neurological abnormalities, aggravate injury to the liver and other organs, suppress the ability of residual hepatocytes to perform organ-specific functions (sick cell syndrome), and inhibit the hepatic regenerative response especially in fulminant hepatitis Virus C which has subacute clinical evolution and takes time to manifest. Liver support technology is evolving as different techniques become available that assist the remaining functional cell mass by providing specific liver functions. Case Presentation: We report a case of Fulminant C virus Hepatitis, successfully treated with albumin dialysis Molecular Adsorbent Recirculating System (MARS). At time of admittance the patient presented: Model End-stage Liver Disease (MELD)-36; Child Turcotte Pugh (CTP)-C(13); Sequential Organ Failure Assestment (SOFA)-12, Glasgow Coma Score (GCS)-11. The patient underwent six sessions of MARS in Intensive Care Unit (ICU) in association with standard medical therapy (SMT). The patient survived and was discharged from the hospital in good condition after 40 days without liver transplantation (LT).
Background: Acute hepatitis C virus infection leading to fulminant hepatitis is very rare whereas Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. The repertoire of substances that accumulate in the blood in fulminant hepatic failure cause neurological abnormalities, aggravate injury to the liver and other organs, suppress the ability of residual hepatocytes to perform organ-specific functions (sick cell syndrome), and inhibit the hepatic regenerative response especially in fulminant hepatitis Virus C which has subacute clinical evolution and takes time to manifest. Liver support technology is evolving as different techniques become available that assist the remaining functional cell mass by providing specific liver functions. Case Presentation: We report a case of Fulminant C virus Hepatitis, successfully treated with albumin dialysis Molecular Adsorbent Recirculating System (MARS). At time of admittance the patient presented: Model End-stage Liver Disease (MELD)-36; Child Turcotte Pugh (CTP)-C(13); Sequential Organ Failure Assestment (SOFA)-12, Glasgow Coma Score (GCS)-11. The patient underwent six sessions of MARS in Intensive Care Unit (ICU) in association with standard medical therapy (SMT). The patient survived and was discharged from the hospital in good condition after 40 days without liver transplantation (LT).
Cite this paper
Morabito, V. , Ferretti, G. , Pugliese, F. , Novelli, S. , Rossi, M. and Novelli, G. (2012) Molecular adsorbent recirculating system therapy in a rare case of fulminant hepatitis. Journal of Biomedical Science and Engineering, 5, 270-275. doi: 10.4236/jbise.2012.55034.
Morabito, V. , Ferretti, G. , Pugliese, F. , Novelli, S. , Rossi, M. and Novelli, G. (2012) Molecular adsorbent recirculating system therapy in a rare case of fulminant hepatitis. Journal of Biomedical Science and Engineering, 5, 270-275. doi: 10.4236/jbise.2012.55034.
References
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[1] Lavanchy, D. (2009) The global burden of hepatitis C. Liver International, 29, 74-81. doi:10.1111/j.1478-3231.2008.01934.x [2] Shepard, C.W., Finelli, L. and Alter, M.J. (2005) Global epidemiology of hepatitis C virus infection. Lancet Infectious Diseases, 5, 558-567. doi:10.1016/S1473-3099(05)70216-4 [3] Koulentaki, M., Ergazaki, M., Moschandrea, J., et al. (2001) Prevalence of hepatitis B and C markers in high-risk hospitalised patients in Crete: A five-year observational study. BMC Public Health, 1, 17. doi:10.1186/1471-2458-1-17 [4] Torresi, J., Johnson, D. and Wedemeyer, H. (2011) Progress in the development of preventive and therapeutic vaccines for hepatitis virus. Journal of Hepatology, 54, 1273-1285. doi:10.1016/j.jhep.2010.09.040 [5] Kubitschke, A., Bahr, M.J., Aslan, N., et al. (2007) Induction of hepatitis C virus (HCV)-speci?c T cells by needle stick injury in the absence of HCV-viraemia. European Journal of Clinical Investigation, 37, 54-64. doi:10.1111/j.1365-2362.2007.01753.x [6] Deterding, K., Wiegand, J., Gruner, N., et al. (2008) Medical procedures as a risk factor for HCV infection in developed countries: Do we neglect a signi?cant problem in medical care? Journal of Hepatology, 48, 1019-1020. doi:10.1016/j.jhep.2008.03.001 [7] Martinez-Bauer, E., Forns, X., Armelles, M., et al. (2008) Hospital admission is a relevant source of hepatitis C virus acquisition in Spain. Journal of Hepatology, 48, 20-27. doi:10.1016/j.jhep.2007.07.031 [8] Esteban, J.I., Sauleda, S. and Quer, J. (2008) The changing epidemiology of hepatitis C virus infection in Europe. Journal of Hepatology, 48,148-162. doi:10.1016/j.jhep.2007.07.033 [9] Sen, S. and Williams, R. (2003) New liver support devices in acute liver failure: A critical evaluation. Seminars in Liver Disease, 23, 283-294. doi:10.1055/s-2003-42646 [10] Bernal, W., Auzinger, G., Dhawan, A. and Wendom, J. (2010) Acute liver failure. Lancet, 376, 190-191. doi:10.1016/S0140-6736(10)60274-7 [11] Sen, S., Williams, R. and Jalan, R. (2005) Emerging indications for albumin dialysis. American Journal of Gastroenterology, 100, 468-475. doi:10.1111/j.1572-0241.2005.40864.x [12] Karvellas, K.J., Gibney, N., Kutsogiannis, D., Wendon, J., et al. (2007) Bench-to-bedside review: Current evidence for extracorporeal albumin dialysis systems in liver failure Critical Care, 11, 215. doi:10.1186/cc5922 [13] Trey, C. and Davidson, C.S. (1970) The management of fulminant hepatic failure. In: Popper, H. and Schaffner, F., Eds., Progress in Liver Diseases. New York: Grune and Stratton, 282-298. [14] Isoniemi, H., Koivusalo, A.M., Repo, H., et al. (2005) The effect of albumin dialysis on cytokine levels in acute liver failure and need for liver transplantation. Transplantation Proceedings, 37, 1088-1090. doi:10.1016/j.transproceed.2004.11.060 [15] Riordan, S.M., Williams, R., et al. (2003) Mechanisms of hepatocyte injury, multiorgan failure, and prognostic criteria in acute liver failure. Seminars in Liver Disease, 23, 203-216. doi:10.1055/s-2003-42639 [16] Schmidt, L.E., Wang, L.P., et al. (2003) Systemic hemodynamic effects of treatment with the molecular adsorbents recirculating system in patients with hyperacute liver failure: A prospective controlled trial. Liver Transplantation, 9, 290-297. doi:10.1053/jlts.2003.50051 [17] Novelli, G., Morabito, V., Rossi, M., et al. (2009) Predictive Criteria for the Outcome of PatientsWith Acute Liver Failure Treated With the Albumin Dialysis Molecular Adsorbent Recirculating System. Therapeutic Apheresis and Dialysis, 13, 404-412. doi:10.1111/j.1744-9987.2009.00759.x