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Kidney Week

Abstract: SA-PO623

Nephrologist Involvement in the Multi-Organ Failure Patient with Artificial Liver Support Systems: Experience of the Single-Center Extracorporeal Therapy Program in Mexico

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Compean, Abel Humberto Villanueva, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • Morales Molina, Pedro, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • Maldonado Tapia, Diana, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • Lopez Mendoza, Monica, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • Prado, Pamela, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • López, Claudia Bethzabé, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • Ramirez, Irving Gaston, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • Nieto, Julio Cesar, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • Cerezo Samperio, Beatriz Rocío, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • Diaz Garcia, Juan Daniel, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
Background

The role of the nephrologist in intensive care is critical and includes the implementation of extracorporeal therapies, such as combined artificial hepatic-renal support, which provides time for rapid inclusion in an emergency liver transplantation program or recovery from acute failure. The most used methods are the molecular adsorbent recirculating system (MARS) and single-pass albumin dialysis (SPAD).

Methods

Objective: To expose the experience in the multiorgan support of critically ill patients with extracorporeal liver and kidney support therapies at the Centro Medico Nacional 20 de Noviembre. Retrospective study of patients with acute liver failure from 2016 to 2023 who underwent MARS or SPAD therapy.

Results

Of 21 patients, 43% were women and 57% men, with an average age of 38 years. The etiology of the liver disease was autoimmune in 47%, hepatitis A infection in 19%, cryptogenic in 14%. Ten of these patients had a previous liver transplant, 47% with recurrence of the disease or chronic rejection; the indication for liver support was 66% for acute chronic liver failure and 34% for acute liver failure, with SOFA score 9.8+8, MELD score 25+15. Five patients received MARS and 16 SPAD, with a total of 63 sessions (average of 3 sessions per patient), with a bilirubin clearance rate of 29.2% (3-47%). Acute kidney injury was present in 62%, of these 54% required CRRT. We found an average survival of 6 months (1 to 56 months) and mortality of 80%.

Conclusion

The use of MARS or SPAD is a therapeutic bridge that allows clinical improvement of the patient or liver (re)transplantation in acute liver failure. Despite the high mortality, there is substantial room for improvement that favors comprehensive care processes in the critically ill patient. Survival of these patients varies according to the severity and availability of donated organs.