Supporting your patient’s liver
Hepatic dysfunction affects key liver functions such as detoxification, synthesis, and metabolic regulation, and is associated with high mortality in intensive care unit (ICU) patients. Extracorporeal Liver Support systems are intended to assist liver detoxification by helping to remove hepatotoxic molecules from the blood.
Next-Level Liver Support
One of the main challenges in Acute Liver Dysfunction (ALD) is auto-intoxication caused by substances normally metabolized or excreted by the liver, such as bilirubin, bile acids, ammonia, and others. Liver auto-intoxication and the systemic hyperinflammation that often accompanies ALD may contribute to progression toward Multi Organ Dysfunction Syndrome (MODS).
CytoSorb® Therapy is designed to support the reduction of selected liver-related toxins and inflammatory mediators as part of a multimodal approach to managing auto-intoxication and immune dysregulation.
Liver support by CytoSorb
CytoSorb is a unique technology proven to effectively, safely, and simultaneously reduce elevated levels of cytokines and bilirubin, thereby promoting hemodynamic stability and recovery of liver function. And as a bridging therapy, CytoSorb has been shown to be superior and easier to apply compared to conventional albumin dialysis.
Hemoadsorption has a different mode of action than dialysis-based therapies have, effectively removing excessive levels of cytokines and liver toxins. Early attenuation of auto-intoxication (and hyperinflammation) can help as a bridging therapy towards liver recovery or transplantation.
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Removal of:
- Bilirubin
- Cytokines
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May support:
- Liver function improvement
- Clinical management
- Hemodynamic stabilization
CytoSorb can be used as part of a multimodal approach to address various challenges associated with liver dysfunction
Manage liver dysfunction
Liver dysfunction can occur in various settings, such as acute-on-chronic liver failure, post-hepatectomy liver failure (PHLF), and acute liver failure.
CytoSorb is a powerful tool to remove bilirubin and other liver toxins efficiently, and to address systemic hyperinflammation via cytokine removal.
Building a vital bridge with CytoSorb
Reduction of systemic inflammation, together with support of excretory liver function, is intended to help bridge patients toward liver stabilization, recovery, or transplantation as part of a multimodal treatment strategy.
CytoSorb Therapy may support the management of liver dysfunction:
Effective bilirubin removal
Support of hepatic excretory function
Attenuation of hyperinflammation
Ease of setup and use
Acute Liver Failure & Secondary Liver Dysfunction
Treatment Rationale & Goals
Support the liver by dual targeting. Removal of bilirubin and bile acids. Attenuation of hyperinflammation. Improvement of hepatic encephalopathy. Support bridge to recovery or transplantation
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Address the cycle of auto-intoxication
Tomescu et al.Support the reduction of bilirubin and bile acids
When liver function is impaired, excretory clearance of bilirubin and bile acids is reduced. As plasma levels of these substances rise, they may contribute to worsening hepatic dysfunction and affect other organs. Managing elevated concentrations of these protein-bound toxins is an important goal within the overall treatment approach to liver dysfunction.
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Address the associated hyperinflammation
Popescu et al.Support the reduction of cytokines and DAMPs/PAMPs
A pronounced inflammatory state can pave the way for further complications. While hepatic inflammation is considered a main driver of liver tissue injury, systemic hyperinflammation with elevated cytokines and DAMPs/PAMPs may contribute to endothelial damage and metabolic disturbances, resulting in impaired micro- and macrocirculatory function.
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Complement liver dialysis procedures
Riva et al.Utilize versatility in liver support applications
In liver dysfunction, extracorporeal support systems aim to address toxin accumulation. While dialysis-based technologies remove primarily water-soluble substances, hemoadsorption is intended to support the reduction of albumin-bound toxins. Compared with more complex extracorporeal systems, CytoSorb can be integrated into an existing circuit with relative ease, allows rapid initiation, and is designed to adsorb a broad range of substances.
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Dampen side effects of liver dysfunction
Haselwanter et al.Support the management of hepatic encephalopathy. Support hemodynamic stabilization.
Beyond tissue damage, a well-recognized risk of liver failure is hepatic encephalopathy, which may be influenced by elevated neurotoxins — such as ammonia—and by systemic hyperinflammation. Hemoadsorption has been investigated as a supportive measure to modulate toxin levels and inflammatory mediators, which may contribute to the clinical management of encephalopathy and hemodynamic instability, including vasopressor demand, as part of a multimodal therapy strategy.
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Support organ tissue protection and function
Turan et al.Gain time for potential organ recovery.
Support bridging toward liver transplantation. Bridging to recovery or liver transplantation is a central objective in the management of severe liver dysfunction. Hemoadsorption may help provide time within a multimodal treatment strategy by addressing both hyperinflammation and toxin accumulation.
Acute on Chronic Liver Dysfunction (ACLF)
Treatment Rationale & Goals
Support the liver by dual targeting. Removal of bilirubin and bile acids. Attenuation of hyperinflammation. Improvement of hepatic encephalopathy. Relief of refractory pruritus. Support bridge to recovery or transplantation.
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Address the cycle of auto-intoxication
Graefe et al.Support the reduction of bilirubin and bile acids
In liver damage, excretory clearance of bilirubin and bile acids becomes impaired. As plasma levels of these toxins rise, they may contribute to hepatic and extrahepatic dysfunction and worsen the clinical condition. Managing elevated levels of these protein-bound substances is an important goal within the therapeutic approach to acute liver dysfunction (ALD).
-
Address the associated hyperinflammation
Haselwanter et al.Support the reduction of cytokines and DAMPs/PAMPs
A pronounced inflammatory state can pave the way to further complications. While hepatic inflammation is considered a main driver of liver tissue damage, systemic hyperinflammation with elevated cytokines and DAMPs/PAMPs may contribute to endothelial injury and metabolic disturbances, ultimately affecting both micro- and macrocirculatory function.
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Complements liver dialysis procedures
Scharf et al.Utilize versatility in liver support applications
In liver dysfunction, extracorporeal support systems aim to address toxin accumulation. Alongside dialysis, which removes primarily water-soluble substances, hemoadsorption is intended to support the reduction of albumin-bound toxins. Compared with more complex extracorporeal systems, CytoSorb® can be integrated into an existing circuit with relative ease, allows rapid initiation, and is designed to adsorb a broad range of substances.
-
Dampens side effects of liver dysfunction
Popescu et al.Support the management of hepatic encephalopathy. Support hemodynamic stabilization. Support relief of refractory pruritus.
Beyond tissue damage, a well-recognized risk of liver failure is hepatic encephalopathy, which may be influenced by elevated neurotoxins—such as ammonia—and by systemic hyperinflammation. Hemoadsorption has been explored as a supportive measure to modulate toxin levels and inflammatory mediators, which may contribute to the clinical management of encephalopathy and hemodynamic instability, including vasopressor requirements. In addition, severe hepatic pruritus may also be alleviated using hemoadsorption as part of a broader treatment strategy.
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Supports organ tissue protection and function
Tomescu et al.Gain time for potential organ recovery. Support bridging toward liver transplantation. Support reduction of subjective suffering / improvement of quality of life.
Bridging to recovery or liver transplantation is a core objective in the management of severe liver dysfunction. Hemoadsorption may help provide time within a multimodal therapy approach by addressing both hyperinflammation and toxin accumulation. In patients with refractory pruritus, hemoadsorption has been reported to contribute to a reduction in symptoms, which may support individual comfort and perceived quality of life.
Additional Information
- Haselwanter et al., Sci Rep 2024; 14(1):11309
- Turan et al., Biomedicines 2024; 12(1):67
- Riva et al., J Art Orgs 2023; epub
- Popescu et al., J Clin Med 2023; 12(6):2258
- Greimel et al., Ann Intensive Care 2023; 13(1):110
- Tomescu et al., Int J Artif Organs 2021; 4(8):560-564
- Jansen et al., Crit Care 2023; 27(1):117
- Riva et al., J Artif Organs 2024; 27(3):261-268
- Forni et al., BMC Neph 2024; 25(1):247
- Dhokia et al., JICS, 2019; Vol. 20(2):174-181
- Frattari et al, Blood Purif 2019; 47(suppl 4):3-37
- Scharf et al., Scientific Reports 2021; 11:10190
- Graefe et al., Sci Rep 2024; 14(1):21762
- Albrecht et al., Blood Purif 2024; 52(2):88-95
- Chavez et al. Crit Care 2016; 20(1):135
CytoSorb 300 IFU 03/2023 – Indications:
CytoSorb is indicated for use in conditions where elevated levels of cytokines and/or bilirubin and/or myoglobin exist. CytoSorb is indicated for use intraoperatively during cardio-pulmonary bypass surgery for the removal of P2Y12-Inhibitor Ticagrelor and/or Factor Xa-Inhibitor Rivaroxaban. Results from current studies suggest that CytoSorb may be administered for up to 7 consecutive days. Maximum Treatment Time per Device: 24 Hour.
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Access Healthcare Professionals Area
This area is for Health Care Professionals only and provides reports about clinical experiences gained during the use of CytoSorbents products. The information presented reflects the opinions and procedural techniques of individual physicians and is not intended as medical advice. Physician experience, risks, patient outcomes and results may vary. This content is intended for Health Care Professionals outside the United States and Canada as CytoSorb has not yet been approved or cleared in the United States or Canada for any indication, except under an Emergency Use Authorization (EUA) by the US FDA.