transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2009-0-2-35-40transplantologiya-253Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSЭкстракорпоральная гемокоррекция в лечении печеночной недостаточностиExtracorporeal hemocorrection in the treatment of liver failureАлександроваИ. В.AleksandrovaI. V.

Ирина Владимировна Александрова

aleksandrovaiv@gmail.comНИИ скорой помощи им. Н.В. СклифосовскогоРоссияN.V. Sklifosovsky Research Institute of Emergency CareRussian Federation200916082018023540Copyright © Александрова И.В., 20182018Александрова И.В.Aleksandrova I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/253

В настоящее время оптимальной стратегией лечения при тяжелой печеночной недостаточности является стабилизация клинического состояния на время, необходимое для спонтанной регенерации органа либо проведения ортотопической трансплантации печени. Применение искусственных систем поддержки функции печени позволяет снизить летальность при тяжелой печеночной недостаточности с 85 до 60%. Искусственные системы поддержки функции печени в зависимости от используемых технологий можно разделить на биологические, небиологические (искусственные, или свободные от клеточных технологий) и биоискусственные, или гибридные устройства. Положительные и отрицательные стороны этих технологий представлены в настоящем обзоре.

As of now, clinical stabilization during the time required for the spontaneous regeneration of the liver or its orthotopic transplantation is the optimum treatment strategy. The use of artificial hepatic function support systems reduces mortality in severe hepatic failure from 85 to 60%. According to the used technologies, these systems can be divided into biological, non-biological (artificial or cell-free technologies), bioartificial or hybrid devices. The positive and negative aspects of these technologies are shown in this review.

печеночная недостаточностьзаместительная терапиясистема искусственной поддержки функции печенисистемы MARSPrometeushepatic failurereplacement therapyhepatic function support systemMARSPrometeusReferencesKim W.R., Brown R.S., Terrault N.A., El-Serag H. Burden of liver desease in the United States: summary of a workshop. Hepatology 2002;36:227—42.Kim W.R., Brown R.S., Terrault N.A., El-Serag H. Burden of liver desease in the United States: summary of a workshop. Hepatology 2002;36:227—42.Palmers D., Qayumi A.K., Spiegel H.U. Liver bridging techniques in the treatment of acute liver failure. J Invest Surg 2000;13:299—311.Palmers D., Qayumi A.K., Spiegel H.U. Liver bridging techniques in the treatment of acute liver failure. J Invest Surg 2000;13:299—311.Palmers D., Skawran S., Palmers H.U. Acute liver failure from bench to bedside. Transplant Proc 2005;37: 1628—31.Palmers D., Skawran S., Palmers H.U. Acute liver failure from bench to bedside. Transplant Proc 2005;37: 1628—31.Kreymann B., Seige M., Schweigart U. et al. Albumin dialysis: effective removal of copper in a patient with fulminant Wilson disease and successful bridging to liver transplantation: a new possibility for the elimination of protein-bound toxins. J Hepatol 1999;31:1080—5.Kreymann B., Seige M., Schweigart U. et al. Albumin dialysis: effective removal of copper in a patient with fulminant Wilson disease and successful bridging to liver transplantation: a new possibility for the elimination of protein-bound toxins. J Hepatol 1999;31:1080—5.Kjaergard L.L., Liu J., Als-Nielsen B., Gluud C. Artificial and bioartificial support systems for acute and acute-on-chronic liver failure: a systematic review. JAMA 2003;289:217—22.Kjaergard L.L., Liu J., Als-Nielsen B., Gluud C. Artificial and bioartificial support systems for acute and acute-on-chronic liver failure: a systematic review. JAMA 2003;289:217—22.De Vriese A.S., Vanholder R.C., Pascual H. et al. Can inflammatory cytokines be removed efficiently by continuous renal replacement therapies? Intensive Care Med 1999;25:903—10.De Vriese A.S., Vanholder R.C., Pascual H. et al. Can inflammatory cytokines be removed efficiently by continuous renal replacement therapies? Intensive Care Med 1999;25:903—10.Ambrosino G., Naso A., Feltracco P. et al. Cytokines and liver failure: modification of TNF and IL-6 in patiens with acute on chronic liver decompensation treated with Molecular Absorbent Regenerating System. Acta Biomed Ateneo Parmense 2003;74(2):7—9.Ambrosino G., Naso A., Feltracco P. et al. Cytokines and liver failure: modification of TNF and IL-6 in patiens with acute on chronic liver decompensation treated with Molecular Absorbent Regenerating System. Acta Biomed Ateneo Parmense 2003;74(2):7—9.Matsubara S., Okabe K., Ouchi K. et al. Continuous removal of middle molecules by hemofiltration in patients with acute liver failure. Crit Care Med 1990;18: 1331—8.Matsubara S., Okabe K., Ouchi K. et al. Continuous removal of middle molecules by hemofiltration in patients with acute liver failure. Crit Care Med 1990;18: 1331—8.Stadlbauer V., Krisper P., Aigner R. et al. Effect of extracorporeal liver support by MARS and Prometeus on serum cytokines in acute-on-chronic liver failure. Crit Care 2006;10:169—74.Stadlbauer V., Krisper P., Aigner R. et al. Effect of extracorporeal liver support by MARS and Prometeus on serum cytokines in acute-on-chronic liver failure. Crit Care 2006;10:169—74.Mitzner S., Stange J., Klammt S. et al. Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure. J Am Soc Nephrol 2001;12:75—82.Mitzner S., Stange J., Klammt S. et al. Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure. J Am Soc Nephrol 2001;12:75—82.Jalan R., Williams R. Acute-on-chronic liver failure: pathophysiological basis of therapeutic options. Blood Purif 2002;20:252—61.Jalan R., Williams R. Acute-on-chronic liver failure: pathophysiological basis of therapeutic options. Blood Purif 2002;20:252—61.Rajvanshi P., Larson A.M., Kowdley K.V. Temporary support for acute liver failure. J Clin Gastroenterol 2002;35: 335—44.Rajvanshi P., Larson A.M., Kowdley K.V. Temporary support for acute liver failure. J Clin Gastroenterol 2002;35: 335—44.Бокерия Л.А., Ярустовский М.Б., Гептнер Р.А. и др. Альбуминовый диализ в комплексной интенсивной терапии больных после кардиохирургических операций. Первый собственный опыт. Анестезиол и реаниматол 2005;(2): 78—83.Бокерия Л.А., Ярустовский М.Б., Гептнер Р.А. и др. Альбуминовый диализ в комплексной интенсивной терапии больных после кардиохирургических операций. Первый собственный опыт. Анестезиол и реаниматол 2005;(2): 78—83.Лужников Е.А., Гольдфарб Ю.С., Мусселиус С.Г. Детоксикационная терапия. Руководство для врачей. СПб.: Лань, 2000.Лужников Е.А., Гольдфарб Ю.С., Мусселиус С.Г. Детоксикационная терапия. Руководство для врачей. СПб.: Лань, 2000.Хорошилов C.E., Гранкин В.И., Скворцов С.В., Пономарев С.В. Лечение острой печеночной и печеночнопочечной недостаточности с применением альбуминового диализа на аппарате MARS. Рос журн гастроэнтерол гепатол колопроктол 2006;(2): 49—54.Хорошилов C.E., Гранкин В.И., Скворцов С.В., Пономарев С.В. Лечение острой печеночной и печеночнопочечной недостаточности с применением альбуминового диализа на аппарате MARS. Рос журн гастроэнтерол гепатол колопроктол 2006;(2): 49—54.Lamesch P., Jost U., Schreiter D. et al. Molecular Adsorbent Recirculating System in patients with liver failure. Transpl Proceed 2001;33:3480—2.Lamesch P., Jost U., Schreiter D. et al. Molecular Adsorbent Recirculating System in patients with liver failure. Transpl Proceed 2001;33:3480—2.Gaspari R., Avolio A.W., Zileri Dal Verme L. et al. Molecular adsorbent recirculating system in liver transplantation: safety and efficacy. Transplantation Proceedings 2006;38:3544—51.Gaspari R., Avolio A.W., Zileri Dal Verme L. et al. Molecular adsorbent recirculating system in liver transplantation: safety and efficacy. Transplantation Proceedings 2006;38:3544—51.Hetz H., Faybik P., Berlakovich G. et al. Molecular adsorbent recirculating system in patients with early allograft dysfunction after liver transplantation: a pilot study. Liver Transpl 2006;(12):1357—64.Hetz H., Faybik P., Berlakovich G. et al. Molecular adsorbent recirculating system in patients with early allograft dysfunction after liver transplantation: a pilot study. Liver Transpl 2006;(12):1357—64.Park J.K., Lee D.H. Bioartifical liver systems: current status and future perspective. J Biosci Bioeng 2005;99:311—9.Park J.K., Lee D.H. Bioartifical liver systems: current status and future perspective. J Biosci Bioeng 2005;99:311—9.Laleman W., Wilmer A., Evenepoel Р. et al. Review article: non-biological liver support in liver failure. Aliment Pharmacol Ther 2006;23:351—63.Laleman W., Wilmer A., Evenepoel Р. et al. Review article: non-biological liver support in liver failure. Aliment Pharmacol Ther 2006;23:351—63.Demetriou A.A., Brown R.S., Busuttil R.W. et al. Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Ann Surg 2004;239:660—7.Demetriou A.A., Brown R.S., Busuttil R.W. et al. Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Ann Surg 2004;239:660—7.Rifai K., Ernst T., Kretschmer U. et al. Removal selectivity of Prometheus: a new extracorporeal liver support device. World J Gastroenterol 2006;(12):940—4.Rifai K., Ernst T., Kretschmer U. et al. Removal selectivity of Prometheus: a new extracorporeal liver support device. World J Gastroenterol 2006;(12):940—4.Sen S., Davis N., Mookerjee R.P. et al. Pathophysiological effects of albumin dyalisis in acute-on-chronic liver failure:f randomized controlled study. Liver Transpl 2004;10:1109—19.Sen S., Davis N., Mookerjee R.P. et al. Pathophysiological effects of albumin dyalisis in acute-on-chronic liver failure:f randomized controlled study. Liver Transpl 2004;10:1109—19.Chamuleau R.A. Poyck P.P., Van de Kerkhove M.P. Bioartifical liver: its pros and cons. Ther Apher Dial 2006;(10):168—74.Chamuleau R.A. Poyck P.P., Van de Kerkhove M.P. Bioartifical liver: its pros and cons. Ther Apher Dial 2006;(10):168—74.Van de Kerkhove M.P., Hoekstra R., Chamuleau R.A., Van Gulik T.M. Clinical application of bioartifical liver support systems. Ann Surg 2004;240: 216—30.Van de Kerkhove M.P., Hoekstra R., Chamuleau R.A., Van Gulik T.M. Clinical application of bioartifical liver support systems. Ann Surg 2004;240: 216—30.Eiseman B., Van Wyk J., Griffen W.O. Methods for extracorporal hepatic assist. Ann Surg Gynec Obstet 1966;123: 522—30.Eiseman B., Van Wyk J., Griffen W.O. Methods for extracorporal hepatic assist. Ann Surg Gynec Obstet 1966;123: 522—30.Abouno G.M., Fisher L.M., Porter K.H., Anders G. Experience in the treatment of hepatic failure by intermittent liver hemoperfusion. Ann Surg Gynec Obstet 1973; 137:74.Abouno G.M., Fisher L.M., Porter K.H., Anders G. Experience in the treatment of hepatic failure by intermittent liver hemoperfusion. Ann Surg Gynec Obstet 1973; 137:74.Шумаков В.И., Писаревский А.А., Онищенко Н.А и др. Коррекция нарушений гомеостаза в организме при тяжелых формах печеночной недостаточности методами физикохимической и биологической детоксикации. Очерки по физиологическим проблемам трансплантологии и применения искусственных органов. Под ред. акад. В.И. Шумакова. Тула: Репроникс Лтд., 1998. с. 93—118.Шумаков В.И., Писаревский А.А., Онищенко Н.А и др. Коррекция нарушений гомеостаза в организме при тяжелых формах печеночной недостаточности методами физикохимической и биологической детоксикации. Очерки по физиологическим проблемам трансплантологии и применения искусственных органов. Под ред. акад. В.И. Шумакова. Тула: Репроникс Лтд., 1998. с. 93—118.Rozga J., Podesta L., Le Page E. et al. A bioartifical liver to treat severe acute liver failure. Ann Surg 1994;219:538—46.Rozga J., Podesta L., Le Page E. et al. A bioartifical liver to treat severe acute liver failure. Ann Surg 1994;219:538—46.Ellis A.J., Hughes R.D., Wendon J.A. et al. Pilot-controlled trial of the extracorporeal liver assist device in acute liver failure. Hepatology 1996;24:1446—53.Ellis A.J., Hughes R.D., Wendon J.A. et al. Pilot-controlled trial of the extracorporeal liver assist device in acute liver failure. Hepatology 1996;24:1446—53.Arkadopoulos N., Detry O., Rozga J. et al. Liver assist system: state of the art. Int Artif Organs 1998;21:781.Arkadopoulos N., Detry O., Rozga J. et al. Liver assist system: state of the art. Int Artif Organs 1998;21:781.Скалецкий Н.Н., Онищенко Н.А. Клеточная трансплантация: достижения и перспективы. Вестн трансплантол и искусств органов 2001;(3—4): 94—102.Скалецкий Н.Н., Онищенко Н.А. Клеточная трансплантация: достижения и перспективы. Вестн трансплантол и искусств органов 2001;(3—4): 94—102.Davenport A. Continuous renal replacement therapy for liver disease. Hemodial Int 2003;7(3):348—52.Davenport A. Continuous renal replacement therapy for liver disease. Hemodial Int 2003;7(3):348—52.Шиманко И.И., Мусселиус С.Г. Острая печеночно-почечная недостаточность. М.: Медицина, 1993.Шиманко И.И., Мусселиус С.Г. Острая печеночно-почечная недостаточность. М.: Медицина, 1993.Detry O., Arkadopoulos N., Ting P. et al. Clinical use of a bioartificial liver in the treatment of acetaminophen-induced fulminant hepatic failure. Am Surg 1999;65: 934—8.Detry O., Arkadopoulos N., Ting P. et al. Clinical use of a bioartificial liver in the treatment of acetaminophen-induced fulminant hepatic failure. Am Surg 1999;65: 934—8.Millis J., Kramer D., Grady J.O. Results of phase I trial of the extracorporeal liver assist device in acute liver failure. Am J Transplant 2001;(1):391—8.Millis J., Kramer D., Grady J.O. Results of phase I trial of the extracorporeal liver assist device in acute liver failure. Am J Transplant 2001;(1):391—8.Samuel D., Ichai P., Feray C. et al. Neurological improvement during bioartificial liver sessions in patients with acute liver failure awaiting transplantation. Transplantation 2002;73:257—64.Samuel D., Ichai P., Feray C. et al. Neurological improvement during bioartificial liver sessions in patients with acute liver failure awaiting transplantation. Transplantation 2002;73:257—64.Shiga Y., Fujihara K., Onodera H. et al. Complement activation as a cause of transient hypotension during plasmapheresis. ArtifOrgans 1998;22(12):1067—9.Shiga Y., Fujihara K., Onodera H. et al. Complement activation as a cause of transient hypotension during plasmapheresis. ArtifOrgans 1998;22(12):1067—9.Winchester J.F., Ratcliffe J.G., Carlyle E., Kennedy A.C. Solute, amino acid and hormone changes with coated charcoal hemoperfusion in uremia. Kidney Int 1978;14(1):74—81.Winchester J.F., Ratcliffe J.G., Carlyle E., Kennedy A.C. Solute, amino acid and hormone changes with coated charcoal hemoperfusion in uremia. Kidney Int 1978;14(1):74—81.Kramer L., Gendo A., Funk G. et al. Clinical experience with artificial liver support in chronic liver failure with encephalopathy. ASAIO J 1997;46(2):211.Kramer L., Gendo A., Funk G. et al. Clinical experience with artificial liver support in chronic liver failure with encephalopathy. ASAIO J 1997;46(2):211.Stange J. Mitzner S. A carrier-mediated transport of toxins in a hybrid membrane. Safety barrier between a patients blood and a bioartificial liver. Int J Artif Organs 1996;19:677—91.Stange J. Mitzner S. A carrier-mediated transport of toxins in a hybrid membrane. Safety barrier between a patients blood and a bioartificial liver. Int J Artif Organs 1996;19:677—91.Stange J., Ramlow W., Mitzner S. et al. Dialysis against a recycled albumin solution enables the removal of albumin-bound toxins. Artif Organs 1993;17:809—13.Stange J., Ramlow W., Mitzner S. et al. Dialysis against a recycled albumin solution enables the removal of albumin-bound toxins. Artif Organs 1993;17:809—13.Хасабов Н.Н. Гусейнова Л.А., Анашкин В.А. и др. Острый токсический гепатит с тяжелым холестатическим синдромом, обусловленный приемом анаболических стероидных гормонов, успешно леченный альбуминовым диализом (MARS). Нефрол и диализ 2003;5(1):82—5.Хасабов Н.Н. Гусейнова Л.А., Анашкин В.А. и др. Острый токсический гепатит с тяжелым холестатическим синдромом, обусловленный приемом анаболических стероидных гормонов, успешно леченный альбуминовым диализом (MARS). Нефрол и диализ 2003;5(1):82—5.Ямпольский А.Ф. Молекулярная адсорбционнорециркулирующая система (МАРС) — новый метод лечения печеночной недостаточности. Первый собственный опыт. Нефрол и диализ 2003;5(1): 15—20.Ямпольский А.Ф. Молекулярная адсорбционнорециркулирующая система (МАРС) — новый метод лечения печеночной недостаточности. Первый собственный опыт. Нефрол и диализ 2003;5(1): 15—20.Evenepoel P., Laleman W., Wilmer A. et al. Prometheus versus molecular adsorbents recirculating system: comparison of efficiency in two different liver detoxification devices. Artif Organs 2006;30:276—84.Evenepoel P., Laleman W., Wilmer A. et al. Prometheus versus molecular adsorbents recirculating system: comparison of efficiency in two different liver detoxification devices. Artif Organs 2006;30:276—84.Awad S.S., Rich P.B., Kolla S. et al. Characteristics of an albumin dialysate hemodiafiltation system for the clearance of unconjugated bilirubin. ASAIO J 1997;43:745—9.Awad S.S., Rich P.B., Kolla S. et al. Characteristics of an albumin dialysate hemodiafiltation system for the clearance of unconjugated bilirubin. ASAIO J 1997;43:745—9.Evenepoel P., Laleman W., Wilmer A. et al. Detoxifying capacity and kinetics of Prometheus- a new extracorporeal system for the treatment of liver failure. Blood Purif 2005;23:349—58.Evenepoel P., Laleman W., Wilmer A. et al. Detoxifying capacity and kinetics of Prometheus- a new extracorporeal system for the treatment of liver failure. Blood Purif 2005;23:349—58.Awad S.S., Rich P., Kolla S. et al. Can the clearance of phenylalanine be enchanced using an albumin dialysate hemodiafiltration system? Surg Forum 1997;48:151—3.Awad S.S., Rich P., Kolla S. et al. Can the clearance of phenylalanine be enchanced using an albumin dialysate hemodiafiltration system? Surg Forum 1997;48:151—3.Loock J., Peters E., Stange J. et al. Change of human serum amino acid patterns (Fischer index) during a new dialysis treatment for liver failure (MARS). Int J Artif Organs 1997;20:500A.Loock J., Peters E., Stange J. et al. Change of human serum amino acid patterns (Fischer index) during a new dialysis treatment for liver failure (MARS). Int J Artif Organs 1997;20:500A.Senf R., Klinge R., Kurz S. et al. Bilirubin-adsorption in 23 critically ill patients with liver failure. Int J Artif Organs 2004;27(4):717—22.Senf R., Klinge R., Kurz S. et al. Bilirubin-adsorption in 23 critically ill patients with liver failure. Int J Artif Organs 2004;27(4):717—22.Laleman W., Wilmer A., Evenepoel P. et al. Effect of the molecular adsorbent recirculation system and Prometheus devices on systemic haemodynamics and vasoactive agents in patients with acute-on-chronic alcoholic liver failure. Crit Care 2006;(10):108.Laleman W., Wilmer A., Evenepoel P. et al. Effect of the molecular adsorbent recirculation system and Prometheus devices on systemic haemodynamics and vasoactive agents in patients with acute-on-chronic alcoholic liver failure. Crit Care 2006;(10):108.Catalina M.V., Barrio J., Anaya F. et al. Hepatic and systemic haemodynamic changes after MARS in patients with acute on chronic liver failure. Liver Int 2003;23(3):39—43.Catalina M.V., Barrio J., Anaya F. et al. Hepatic and systemic haemodynamic changes after MARS in patients with acute on chronic liver failure. Liver Int 2003;23(3):39—43.Sen S., Mookerjee R.P., Cheshire L.M. et al. Albumin dialysis reduces portal pressure acutely in patiens with severe alcoholic hepatitis. Hepatology 2005;43(1): 142—8.Sen S., Mookerjee R.P., Cheshire L.M. et al. Albumin dialysis reduces portal pressure acutely in patiens with severe alcoholic hepatitis. Hepatology 2005;43(1): 142—8.Mitzner S., Stange J., Klammt S. et al. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized clinical trial. Liver Transpl 2000;6(3): 277—86.Mitzner S., Stange J., Klammt S. et al. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized clinical trial. Liver Transpl 2000;6(3): 277—86.Kramer L., Gendo A., Funk G. et al. Clinical experience with artificial liver support in chronic liver failure with encephalopathy. ASAIO J 1997; 46(2):211.Kramer L., Gendo A., Funk G. et al. Clinical experience with artificial liver support in chronic liver failure with encephalopathy. ASAIO J 1997; 46(2):211.

The authors declare that there are no conflicts of interest present.