Successful treatment of acute liver failure by means of artificial liver support device „Prometheus“ with following liver transplantation.

Overview

Acute (fulminant) liver failure is defined as a sudden onset of icterus, severe coagulopathy and encephalopathy in a patient without previous symptoms of liver disease. The condition is potentially reversible due to the high regenerative capacity of the liver; however a significant proportion of patients has no chance of survival without prompt liver transplantation. Despite of all the advances in medicine, liver failure is still associated with high mortality. The complex treatment of acute liver failure consists of therapy of intracranial hypertension, stabilisation of circulation, ensuring appropriate ventilation and oxygenation, nutritional support and maintenance of metabolic homeostasis, specific treatment of infections. Time is the most important factor for survival. It is necessary to recognize the disease early, start the treatment and contact a liver centre that performs liver transplantation. As the transport of a patient with hepatic encephalopathy is associated with a high risk, it is necessary to refer the patient early, preferably in stage I or II of hepatic encephalopathy. Artificial liver support, although not yet a standard part of the treatment protocol, may prolong the period when the patient’s condition is still suitable for liver transplantation. In July 2005, the “Prometheus” device, which works on the principle of fractionated plasma separation and adsorption, was used for the first time in a patient with acute liver failure in the Czech Republic.

Key words:
acute liver failure, Budd-Chiari syndrome, artificial liver support, „Prometheus“, liver transplant.