[Albumin dialysis (MARS therapy) in patients with hepatic graft dysfunction].

ABSTRACT

A primary nonfunctioning graft, the complication that develops in less than 5% of patients within the first 24-48 hours after hepatic transplantation, is responsible for high death rates in recipients. Its manifestations are an extremely grave clinical condition, hypotension, unconsciousness, progressive signs of hepatocytic insufficiency with increases in bilirubin levels and serum transaminase activities, addition of renal failure, and development of multiple organ dysfunctions. Eight patients underwent a total of 17 albumin dialysis sessions (1 to 5; mean 2.1). Each session lasted 6 hours. Albumin dialysis caused a significant reduction in the levels of serum bilirubin and its conjugated fraction, by an average of 24.7 +/- 15.1% per session. The activity of the serum enzymes of cytolysis and cholestasis significantly decreased with the parameters being stabilized within 7 days. Stabilization of hemodynamic parameters and better neurological status were noted in patients during treatment. The survival rate was 75% on days 7, 20, and 30. Hepatic retransplantation was made in 2 patients; 4 were discharged home and 2 died from multiple organ dysfunctions. Albumin dialysis used in patients with graft dysfunction provides a possibility of maintaining the patient in the critical period of searching for a donor's organ or regenerating the graft's function.