Improvement of impaired albumin binding capacity in acute-on-chronic liver failure by albumin dialysis.

Abstract

Extracorporeal albumin dialysis (ECAD) enables the elimination of albumin bound substances and is used as artificial liver support system. Albumin binding function for the benzodiazepine binding site specific marker Dansylsarcosine was estimated in plasma samples of 22 patients with cirrhosis and hyperbilirubinaemia (ECAD: n = 12; control: n = 10) during a period of 30 days in a randomized controlled clinical ECAD trial. Albumin Binding Capacity (ABiC) at baseline was reduced to 31.8% (median; range 24%-74%) and correlated to the severity of liver disease. Within two weeks a significant improvement of ABiC and a reduction of the albumin bound markers bilirubin and bile acids were observed in the ECAD group. During single treatments a significant decrease of albumin bound substances (bilirubin and bile acids) as well as an increase in ABiC was observed. In the control group, baseline ABiC was significantly lower in patients who died during study period (34.2% vs. 41.7%; P < 0.028), whereas no significant differences were observed for CHILD, coagulation factors, albumin, bile acids nor bilirubin. At baseline 13 patients had a severely impaired ABiC (<40%), improvement of ABiC was more frequent in the ECAD group (5/6) than in the SMT group (2/7). Reduced albumin binding function is present in decompensated liver failure and is related to severity and 30 day survival. ABiC can be improved by ECAD. The beneficial effect of this treatment may be related to the improvement of albumin binding function more than to the elimination of specific substances. Characterization of albumin function by the ABiC test may help to evaluate different liver support systems and other therapeutic measures.

• Authors: Sebastian Klammt, Steffen R Mitzner, Jan Stange, Jan Loock, Uwe Heemann, Jörg Emmrich, Emil C Reisinger, Reinhard Schmidt
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 14 Issue 9 Pg. 1333-9 (Sep 2008) ISSN: 1527-6473 [Electronic] United States
• PMID: 18756471 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Albumins
• Bile Acids and Salts
• Dansyl Compounds
• dansylsarcosine
• Benzodiazepines
• Bilirubin
• Sarcosine

Topics

• Adult
• Albumins (chemistry, metabolism)
• Benzodiazepines (chemistry)
• Bile Acids and Salts (chemistry)
• Bilirubin (chemistry)
• Binding Sites
• Dansyl Compounds (chemistry)
• Dialysis (methods)
• Female
• Fibrosis (metabolism)
• Humans
• Liver Failure (therapy)
• Male
• Middle Aged
• Sarcosine (analogs & derivatives, chemistry)
• Treatment Outcome