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Related Experiment Videos

Prometheus system: a technological support in liver failure.

A Santoro1, S Faenza, E Mancini

  • 1Operative Unit of Nephrology, Dialysis and Hypertension, Department of Nephrology and Urology, Sant'Orsola-Malpighi Hospital, Bologna, Italy. santoro@aosp.bo.it

Transplantation Proceedings
|June 8, 2006
PubMed
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The Prometheus system, using plasma filtration adsorption and hemodialysis (FPSA), effectively purifies blood in liver failure patients by removing toxic substances. This blood purification treatment showed significant reductions in bilirubin, ammonia, and inflammatory markers, improving patient outcomes.

Area of Science:

  • Nephrology and Hepatology
  • Biomedical Engineering
  • Critical Care Medicine

Background:

  • Liver failure leads to the accumulation of toxic substances in the blood, necessitating effective blood purification strategies.
  • Existing treatments may not adequately address both protein-bound and water-soluble toxins common in liver insufficiency.

Purpose of the Study:

  • To evaluate the efficacy and safety of the Prometheus system, a plasma filtration adsorption and hemodialysis (FPSA) device, for blood purification in patients with liver failure.
  • To assess the impact of FPSA treatment on key biochemical markers and inflammatory mediators.

Main Methods:

  • The Prometheus system, combining adsorption and hemodialysis, was used in 12 patients with acute or acute-on-chronic liver insufficiency.
  • Plasma was filtered to remove protein-bound toxins via two adsorbers (p01 and p02), followed by hemodialysis for water-soluble substances.

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  • Measurements included total bilirubin, cholic acid, ammonia, urea, creatinine, soluble interleukin-2 receptor (sIL-2R), and interleukin-6 (IL-6).

    • Main Results:

    • Significant reductions were observed in total bilirubin (mean decrease of 34%), cholic acid (48.6%), and ammonia (51.6%).
    • High clearance rates for urea (57.6%) and creatinine (42.7%) were achieved.
    • Circulating levels of sIL-2R and IL-6 were significantly reduced, indicating an anti-inflammatory effect.

    Conclusions:

    • The Prometheus system, utilizing FPSA, demonstrates high efficacy in clearing both protein-bound and water-soluble toxins in liver failure patients.
    • The treatment was hemodynamically stable and associated with significant reductions in key markers of liver dysfunction and inflammation.
    • While overall survival at 30 days was 41.6%, the system showed promise in managing severe liver insufficiency and secondary insults.