The Effect of Prometheus Device on Laboratory Markers of Inflammation and Tissue Regeneration in Acute Liver Failure Management M. Rocen, E. Kieslichova, D. Merta, E. Uchytilova, Y. Pavlova, J. Cap, and P. Trunecka ABSTRACT Prometheus, based on modified fractionated plasma separation and adsorption (FPSA) method, is used in the therapy of acute liver failure as a bridge to liver transplantation. As the therapeutic effect of Prometheus is caused not only by the elimination of terminal metabolites, the aim of the study was to identify the effect of FPSA on the levels of cytokines and markers of inflammation and liver regeneration. Previous studies assessing cytokine levels involved mostly acute-on-chronic liver failure patients. Data concerning markers of inflammation and liver regeneration are not published yet. Eleven patients (three males, eight females) with acute liver failure were investigated. These patients underwent 37 therapeutic sessions on Prometheus device. Before and after each treatment, the plasma levels of selected cytokines, tumor necrosis factor alpha (TNF), C-reactive protein (CRP), procalcitonin (PCT), hepatocyte growth factor (HGF), and  1 fetoprotein, were measured, and the kinetics of their plasma concentrations was evaluated. Before the therapy, elevated levels of interleukin (IL)-6, IL-8, IL-10, TNF, CRP, and PCT were detected. The level of TNF, CRP, PCT, and  1 fetoprotein decreased significantly during the therapy. In contrast, an increase of HGF was detected. The decline of IL-6, IL-8, and IL-10 concentrations was not significant. Our results show that Prometheus is highly effective in clearing inflammatory mediators responsible for systemic inflammatory re- sponse syndrome and affects the serum levels of inflammatory and regeneration markers important for management of acute liver failure. A CUTE LIVER FAILURE (ALF), a clinical syndrome charecterized by rapid development of severe impair- ment of hepatic function in a patient with no previous liver disease, progresses to hepatic encephalopathy within 8 weeks of onset. Invariably, bilirubin elevation and severe coagulopathy are present. Complete loss of hepatic func- tion leads to rapid development of multiorgan failure. The syndrome is potentially reversible because of the regenera- tive capacity of the liver. However, despite advances in intensive care and liver support therapy, when the regener- ation process is insufficient, fully developed ALF is associ- ated with 80% mortality. Emergency liver transplantation is the only effective treatment, and time is the most important factor for the patient’s survival. Viral hepatitis, toxins, and ischemia are considered to be the main causes of ALF. O’Grady and colleagues have proposed three clinical subunits of ALF, based on different likelihoods of survival and defined by the time interval between the onset of jaundice and the onset of encepha- lopathy. 1 Newer classifications have been developed to reflect differences in presentation and outcome of ALF. King’s College Criteria and Clichy Criteria are widely used indexes. 2 Hepatic dysfunction is caused by hepatocytes damage on the cellular or subcellular level (eg, mitochondria). Hepatic cells have enormous regeneration potential; however, this ability is not unlimited. Hepatic parenchymal necrosis of more than 50% or decreased liver volume measured by From the Anesthesiology and Intensive Care Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Supported by the Research project IGA NR/9405-3 of the Czech Ministry of Health. Address reprint requests to Dr Milan Rocen, Institute for Clinical and Experimental Medicine, Anesthesiology and Inten- sive Care Unit, Videnska 1958/9, Prague, Czech Republic. E-mail: mirc@medicon.cz 0041-1345/10/$–see front matter © 2010 Published by Elsevier Inc. doi:10.1016/j.transproceed.2010.07.103 360 Park Avenue South, New York, NY 10010-1710 3606 Transplantation Proceedings, 42, 3606 –3611 (2010)