FP544
PROMETHEUS LIVER SUPPORT THERAPY IN HUNGARY Free

Introduction and Aims: The liver support therapies were introduced in 2005 in Hungary, and since January 2013 they have been covered by the Hungarian National Health Insurance Authority. In this study we assessed the efficacy of Prometheus liver support therapy and its benefit on patient survival.

Methods: Between May 2005 and August 2014 Prometheus Liver Support was employed for 16 patients (mean age: 39 years, max: 60, min: 4 years, ratio M/F: 9/7, number of treatments: 53). Among the patients 10 had acute liver failure. (4 poisoning, 2 autoimmune hepatitis, one of them with toxic liver damage (Cimicifuga racemosa), 2 hepatitis B viral infection with a reactivation and hepatitis delta virus superinfection, 1 septic patient following bone marrow transplantation and 1 with unknown origin. There were 3 acute-on-chronic liver failures (1 autoimmune hepatitis, 1 hepatitis C virus infection, 1 Wilson disease). Liver graft failure also occurred, 1 patient was diagnosed with chronic rejection and 2 with primary graft dysfunction. Liver failure was accompanied by stage 3 acute kidney injury in 4 patients.

Results: Prometheus Liver Support decreased total bilirubin level in serum from 398±175 umol/L to 253/±127 umol/L (p=0,0000), conjugated form from 255±158 umol/L to 160±113 umol/L (p=0,0000), non-conjugated bilirubin from 130±69 umol/L to 94±51 umol/L (p=0,0003), bile acid from 130±160 g/L to 69±102 g/L (p=0,0002), and ammonia from 57±40 umol/L to 41±24 umol/L (p=0,0019). Seven patients survived (43,75 %) - 4 via bridging to liver transplantation and 3 recovered. Mean survival time without transplantation or regeneration was 8 days with minimum of 1 day and maximum of 22 days.

Conclusions: We conclude that Prometheus Liver Support is an efficient therapy of liver failure providing bridging time until liver transplantation or regeneration of liver parenchyma occurs. Further follow up are needed to confirm the extent of benefit of liver support.