Serum aminotransferase activity and mortality risk

✍ Scribed by Daniele Prati; Agostino Colli; Laura Porretti

• Book ID: 102240066
• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 54 KB
• Volume: 48
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.22361

✦ Synopsis

major benefit of extracorporeal albumin dialysis in the management of patients with liver failure". We disagree with this last comment for the following reasons: (1) The response to therapy was clearly defined and the evaluation tools established at the time of the trial design, and methodological procedures were carefully conducted during the trial; (2) The use of new approaches for the evaluation of HE seems reasonable considering that, as the authors mention, there is no widely used scale in this setting. Moreover, the outcome measures implemented in the trial consider maintenance of the treatment effect through time such that any improvement in HE will also be identified. It is important to emphasize that the trial was neither designed nor powered to detect differences in survival. Thus, failure of albumin dialysis to reduce mortality does not necessarily translate to failure of the experimental arm; (3) The results of this trial are in agreement with previous studies assessing albumin dialysis in which improvements in both relevant physiopathological variables 3,4 and clinical outcomes, including survival, 5 have been noted; (4) Finally, we believe that the results of this trial should be analyzed not only in the context of treatment efficacy but should also be considered for their potential contribution in the design of new hypotheses, the selection of a more adequate target population, etc. In addition, it is important to remark that the use of albumin dialysis in severely affected patients was associated with no significant safety problems. From this perspective, we believe that the results of the trial by Hassanein et al. are truly encouraging and support ongoing large-scale randomized trials with major applications for the future development of artificial liver support in the treatment of liver failure.