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Technology insight: artificial extracorporeal liver support--how does Prometheus compare with MARS?
Peter Krisper1, Rudolf E Stauber
1Universitaetsklinik für Innere Medizin, Abteilung für Nephrologie und Hämodialyse, Graz, Austria. peter.krisper@klinikum-graz.at
Nature Clinical Practice. Nephrology
|April 26, 2007
Summary
Artificial liver support, or liver dialysis, remains experimental. While Prometheus shows promise in toxin removal compared to MARS, its impact on patient survival requires further study in the ongoing HELIOS trial.
Area of Science:
- Hepatology
- Nephrology
- Critical Care Medicine
Background:
- Artificial extracorporeal liver support, including albumin dialysis variants like MARS, is increasingly used for severe liver failure.
- Liver dialysis is considered experimental due to unproven survival benefits in large randomized trials.
Purpose of the Study:
- To evaluate Prometheus, a novel device for fractionated plasma separation, designed to enhance albumin-bound toxin removal.
- To compare the efficacy and safety of Prometheus against the established MARS system.
Main Methods:
- Fractionated plasma separation using an albumin-permeable filter (Prometheus).
- Head-to-head comparisons with Molecular Adsorbents Recirculating System (MARS).
- Initiation of the HELIOS study, a large randomized controlled trial for Prometheus survival outcomes.
Main Results:
- Prometheus demonstrated greater efficiency in removing albumin-bound and water-soluble markers compared to MARS in initial studies.
- Prometheus feasibility and safety were established, with potential benefits in hepatic encephalopathy and pruritus noted in small studies.
- A recent comparison showed MARS provided hemodynamic improvement, unlike Prometheus.
Conclusions:
- Prometheus shows enhanced detoxification capacity, but its clinical benefit and impact on patient survival are yet to be confirmed by large-scale trials.
- The ongoing HELIOS study is critical for determining Prometheus's role in extracorporeal liver support.
