CHICAGO --- Adding albumin to a dialysis solution may help patients wake up faster from coma due to chronic liver failure, according to researchers at Northwestern University Medical School.
The Northwestern scientists are conducting a controlled study of a new "artificial liver" that uses albumin -- a protein that is produced naturally by the body and is a major component of human blood plasma -- to remove toxins from the blood of patients in chronic liver failure who are comatose.
The new "artificial liver" is called a molecular adsorbent recirculation system, or MARS. With MARS, toxic substances in the blood bind to the albumin, cross into the dialysis solution and are therefore removed from the body. The Northwestern study will assess whether patients in hepatic coma exposed to MARS will wake up sooner.
Unlike other "artificial" or "bioartificial" liver devices, the MARS involves no exposure to animal or human material. Additional advantages may be lower cost and easy applicability of the technology.
"The promise of "bioartificial" systems -- the ability to replace the capacity of the liver to produce new proteins -- has not yet been met. The current focus of all these systems, artificial and bioartificial, is to improve the ability to clear the blood of toxins that accumulate in liver disease," said Andres Blei, M.D., professor of medicine and principal investigator for the MARS study at Northwestern. Blei is chief of the division of hepatology at the Medical School and at Northwestern Memorial Hospital.
Currently, over 12,000 patients are waiting for a liver transplant, but only 4,000 transplants are done annually. Up to 20 percent of the patients on the liver transplant waiting list die.
"Thus, there is an urgent need to develop systems that will support patients with chronic liver disease in advance stages of decompensation," Blei said.
Blei said that if use of MARS yields positive results, the scope of the study may be expanded to include the effect of MARS on other complications of chronic liver disease, such as renal failure and pruritus (itching).
To qualify for the MARS study, patients must have cirrhosis of the liver and stage III or IV encephalopathy (coma), no evidence of active hemorrhage and a family member able to provide consent. Because this is a controlled clinical study, half of the patients will be placed on the MARS device and half will not.
Other sites for the MARS study include the University of California San Diego, the University of Michigan and Columbia University.
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