8 research outputs found
Meta-analysis of individual patient data of albumin dialysis in acute-on-chronic liver failure:focus on treatment intensity
Background: Acute-on-chronic liver failure (ACLF) is a common complication of cirrhosis
characterized by single or multiple organ failures and high short-term mortality. Treatment
of ACLF consists of standard medical care (SMC) and organ(s) support. Whether the efficacy
of artificial liver support (ALS) depends on the severity of ACLF or on the intensity of this
treatment, or both, is unclear. This study aimed to further assess these issues.
Methods: We performed an individual patient data meta-analysis assessing the efficacy
of Molecular Adsorbent Recirculating System (MARS) in ACLF patients enrolled in prior
randomized control trials (RCTs). The meta-analysis was designed to assess the effect of
patient severity (ACLF grade) and treatment intensity [low-intensity therapy (LIT), SMC alone
or SMC plus â©˝ 4 MARS sessions, high-intensity therapy (HIT), SMC plus > 4 MARS sessions]
on mortality.
Results: Three RCTs suitable for the meta-analysis (n=285, ACLF patients=165) were
identified in a systematic review. SMC plus MARS (irrespective of the number of sessions)
did not improve survival compared with SMC alone, neither in the complete population nor in
the ACLF patients. Survival, however, was significantly improved in the subgroup of patients
receiving HIT both in the entire cohort (10-day survival: 98.6% versus 82.8%, p=0.001; 30-day
survival: 73.9% versus 64.3%, p=0.032) and within the ACLF patients (10-day survival: 97.8%
versus 78.6%, p=0.001; 30-day survival: 73.3% versus 58.5%, p=0.041). Remarkably, HIT
increased survival independently of ACLF grade. Independent predictors of survival were age,
Model for End-Stage Liver Disease (MELD), ACLF grade, number of MARS sessions received,
and intensity of MARS therapy.
Conclusion: HIT with albumin dialysis may improve survival in patients with ACLF. Appropriate
treatment schedules should be determined in future clinical trials
European renal best practice guideline on the management and evaluation of the kidney donor and recipient
El objetivo de esta guĂa de práctica clĂnica es ofrecer
orientaciĂłn para la evaluaciĂłn tanto del donante como
del receptor del trasplante de riñón y para el manejo del
receptor durante el perĂodo perioperatorio. Ha sido diseñada
para informar y asistir en la toma de decisiones. En ningĂşn
caso pretende definir una norma asistencial ni su carácter
debe concebirse como tal ni interpretarse como prescriptivo
de un manejo exclusivo. La versiĂłn original de esta guĂa
fue publicada en la revista Nephrology, Dialysis and
Transplantation. Esta versiĂłn reducida pretende colaborar
en la divulgaciĂłn de esta guĂa en los paĂses y las comunidades
trasplantadoras hispanohablantes
Meta-analysis of individual patient data of albumin dialysis in acute-on-chronic liver failure: focus on treatment intensity
Background: Acute-on-chronic liver failure (ACLF) is a common complication of cirrhosis characterized by single or multiple organ failures and high short-term mortality. Treatment of ACLF consists of standard medical care (SMC) and organ(s) support. Whether the efficacy of artificial liver support (ALS) depends on the severity of ACLF or on the intensity of this treatment, or both, is unclear. This study aimed to further assess these issues. Methods: We performed an individual patient data meta-analysis assessing the efficacy of Molecular Adsorbent Recirculating System (MARS) in ACLF patients enrolled in prior randomized control trials (RCTs). The meta-analysis was designed to assess the effect of patient severity (ACLF grade) and treatment intensity [low-intensity therapy (LIT), SMC alone or SMC plus ⩽ 4 MARS sessions, high-intensity therapy (HIT), SMC plus > 4 MARS sessions] on mortality. Results: Three RCTs suitable for the meta-analysis (n = 285, ACLF patients = 165) were identified in a systematic review. SMC plus MARS (irrespective of the number of sessions) did not improve survival compared with SMC alone, neither in the complete population nor in the ACLF patients. Survival, however, was significantly improved in the subgroup of patients receiving HIT both in the entire cohort (10-day survival: 98.6% versus 82.8%, p = 0.001; 30-day survival: 73.9% versus 64.3%, p = 0.032) and within the ACLF patients (10-day survival: 97.8% versus 78.6%, p = 0.001; 30-day survival: 73.3% versus 58.5%, p = 0.041). Remarkably, HIT increased survival independently of ACLF grade. Independent predictors of survival were age, Model for End-Stage Liver Disease (MELD), ACLF grade, number of MARS sessions received, and intensity of MARS therapy. Conclusion: HIT with albumin dialysis may improve survival in patients with ACLF. Appropriate treatment schedules should be determined in future clinical trials.status: publishe
DoporueÄŤenĂ© postupy European Renal Best Practice (ERBP) pro posuzovánĂ dárcĹŻ a pĹ™ĂjemcĹŻ pro transplantaci ledviny a pro perioperaÄŤnĂ pĂ©ÄŤi
SCOPUS: re.jinfo:eu-repo/semantics/publishe