ASSESSMENT OF THE EFFICIENCY OF ALBUMIN DIALYSIS WITH THE "PROMETHEUS" SYSTEM IN THE TREATMENT OF PATIENTS WITH ACUTE-ON-CHRONIC LIVER FAILURE

For several decades scientists have been trying to find an effective method for treating patients with acute-on-chronic liver failure (AoCLF). At present, liver transplantation is the only recognised method of treatment in such cases, which, however, is not widely applied due to the highly specialised nature of the procedure, its high costs, and most of all, a limited pool of organs for transplantation. In order to increase the likelihood of liver regeneration and of avoiding transplantation of this organ, various non-biological and biological liver support systems are being employed. The above devices are also used to stabilise or improve the patient’s overall condition until liver transplantation, should it be necessary. One such device used for albumin dialysis procedure is the “Prometheus” system. The aim of the thesis was to assess the use of the “Prometheus” system (FPSA - Fractionated Plasma Separation and Adsorption) in the treatment of patients with acute-on-chronic liver failure. A retrospective analysis was conducted on 134 patients treated in the Department between 2001 and 2012 for AoCLF. Patients were divided into a 31-person group that received standard therapy – the AoCLF-SMT group and a 103-person group of patients that additionally received albumin dialysis – the AoCLF-FPSA group. The groups were compared independently within each disease entity. Biochemical markers of liver function, kidney function, morphological parameters and vital functions before and after standard therapy, as well as before and after the albumin dialysis treatment with the “Prometheus” system were analysed and compared. The examination involved complications of both therapies. The survival of patients was compared across the following periods: a month, 12 months, and 144 months (12 years of follow-up), showing respectively 50.5%, 38.8% and 37.9% survival rates in the AoCLF-FPSA group and 22.6%, 12.9% and 9.7% survival rates in the AoCLF-SMT group. Conclusions from the research were as follows: 1. Albumin dialysis with the “Prometheus” system was found to be efficient in the treatment of patients with acute-on-chronic liver failure through decreasing the levels of total bilirubin concentration in patient’s blood and significantly improving kidney function, as well as positively impacting the patients’ central nervous system function through reducing the degree of encephalopathy. 2. Following the application of albumin dialysis therapy with the “Prometheus” system in patients with acute-on-chronic liver failure, there is a decrease in blood serum albumin levels. 3. The use of albumin dialysis with the “Prometheus” system increases the survival of patients with acute-on-chronic liver failure with high degree of liver encephalopathy and high MELD scores, which depends mainly on the bilirubin concentration in the blood serum.