Post Hepatectomy Liver Failure Clinical Trial
Official title:
Early Postoperative Extracorporal Liver Support Therapy (ELS) as a Tool to Manage Post Hepatectomy Liver Failure (PLF)
Early postoperative extracorporal liver support therapy (ELS) as a tool to manage post
hepatectomy liver failure (PLF).
Post-operative liver failure (PLF) has been identified as a major risk factor leading to
increased morbidity and mortality. The incidence of PLF varies largely between 0-30%, and may
be accounted for the main reason of postoperative mortality related to liver surgery
(reported figures ranging from 18 to 75 %).
Currently, there are only a few treatment options for PLF, mainly restricted to the treatment
of complications like bile leakage, infections as well as the prevention of further liver
damage caused by e.g. thrombosis or haemorrhage as well as administration of liver toxic
drugs. Recently the international study group on liver surgery (ISGLS) published criteria for
a new definition of PLF which will greatly facilitate the comparison of results from future
studies on a variety of aspects on liver failure.
ELS by using the Molecular Adsorbent Recirculating System (MARS) is based on a modified
haemodialysis that allows the removal of water-soluble and protein bound toxins over an
albumin-coated high flux membrane against recycled exogenous albumin. Thus, MARS can support
the compromised detoxification capacity of the liver as well as improve physiological
parameters. This would offer the potential for temporary support for the harmed liver after
liver resection allowing for a more uneventful recovery.
For obvious reasons previous reports contain few patients, present heterogonous treatment
groups and all suffer from lack of standardized treatment protocols. Few if any surviving
patients, thus providing no evidence to encourage ELS as a possible treatment option for
patients suffering of PLF. However, studies with defined patient populations and treatments
according to a predefined standardised treatment protocol are warranted.
Primary issues to be addressed:
1. Can ELS be applied in an early phase of PLF?
2. Is ELS safe and feasible for the treatment of PLF when practised according to a
predefined protocol?
Secondary issues to be addressed:
1. The development of predictive laboratory-chemical markers of liver failure
2. Indirect measures of portal flow and portal pressure
3. Indocyanine green clearance (ICG) under ELS treatment
4. Clearance of toxic products as assessed in aliquots taken from the dialysate
Primary issues to be addressed
1. Can ELS be applied in an early phase of PLF?
2. Is ELS safe and feasible for the treatment of PLF when practised according to a
predefined protocol?
Secondary issues to be addressed
1. The development of predictive laboratory-chemical markers of liver failure
2. Indirect measures of portal flow and portal pressure
3. Indocyanine green clearance (ICG) under ELS treatment
4. Clearance of toxic products as assessed in aliquots taken from the dialysate
Design
- Prospective phase 1 safety and feasibility study
Study Population
- 10 consecutive patients being subjected to extended liver surgery (at least right sided
or extended right/left sided hemihepatectomy)
;