THE ImPOrTANCE OF EXTrACOrPOrEAL LIvEr SuPPOrT SYSTEmS IN THE TrEATmENT OF HEPATOrENAL SYNdrOmE

Hepatorenal syndrome (HRS) is a functional reversible renal failure that occurs in patients with advanced liver cirrhosis or acute hepatic failure. The mean characteristic of HRS is renal ischemia secondary to hypotension and profound renal cortical vasoconstriction as a consequence of activation of systemic and local vasoconstrictors. Pharmacological treatment of HRS, using mostly terlipressin, midodrine or octreotid, is focused on vasoconstriction of dilated splanchnic arterial beds leading to increase of systemic arterial pressure and renal perfusion pressure and suppression of endogenous vasoconstrictor systems. Nonpharmacological treatment of HRS includes transjugular intrahepatic portosystemic shunts, renal and liver supports represented by modified methods of dialysis such as extracorporeal albumin dialysis (ECAD) and liver transplantation. The most frequently applied sort of albumin dialysis, MARS method (molecular adsorbents recirculating system), is based on dialysis across an albumin-impregnated membrane using 20% albumin in dialysate. Charcoal and anion exchange resins in the second circuit purify and regenerate the binding sites on albumins in dialysate. Not so often used method of Prometheus combines the fractional plasma separation and adsorption by polysulfone filters permeable for albumin and adsorbents that regenerate the filtered plasma. These kinds of renal and liver support showed better biochemical profile and haemodinamical and neurological improvement, and in trials with small number of patients longer survival was shown. For the time being, they are only buying time for the patients who are waiting for the liver transplantation as the only causal solution.