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19th ISAD

The International Liver Support Meeting Rostock

OPAL vs. MARS: a case control study of two extracorporeal albumin dialysis techniques

Extracorporal albumin dialysis (ECAD) is used in patients with liver failure to enable native liver recovery and bridge to liver transplantation. Molecular adsorbent recirculating system (MARS) therapy has demonstrated beneficial effects on symptoms of liver disease and has been proved to be a safety procedure. Open albumin dialysis (OPAL) is still new and uses a different type of adsorber that may lead to better clearance rates due to a better processed albumin. To date there exist no systematic comparison of these two systems. The aim of this study was to compare both ECAD techniques OPAL and MARS in patients with liver failure with respect to treatment related patient conditions, liver function parameters and safety concerns.

In a case control study 28 patients with liver failure received at least three ECAD treatments. 14 patients were treated with MARS and matched to 14 patients, which were treated with OPAL. Indication for ECAD was progressive icterus with liver failure (bilirubin >12 mg/dL) without evidence of extrahepatic origin. To eliminate confounding, individual case-control patient matching was performed. Both MELD Score and number of platelets were selected matching variables with a maximum of 10% difference in value. Outcome analysis included clinical and laboratory parameters recorded before and after each treatment as well as dialysis related side effects and adverse events.

In addition to improved or stable laboratory parameters (reduced bilirubin-values MARS-group -18,1 % and OPAL-group -20% to baseline; stable liver function and renal function parameters), the short-term mortality (up to day 21) was 0% as well in the MARS as in the OPAL group. As a consequence of ECAD treatments thrombocytes values decreased (MARS -31% and OPAL -27 % to baseline), but did not differ significantly between the groups. During all ECAD-procedures every patient of both groups was hemodynamically stable. In the MARS-group we observed 3 adverse events which were not related to the dialysis procedures. In the OPAL-group the number of adverse events was 4, one of them was related to the procedure (catheter-infection).

The study shows for the first time that both procedures are effective and that the OPAL system can be applied safely.

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