Comparison of the liver support systems OPAL and ALBUNIQUE in critically ill patients with liver dysfunction

Background: Liver dysfunction is a common phenomenon in critically ill patients. Extracorporeal albumin dialysis (ECAD) is established in supporting liver function as a bridge to transplant or recovery. ECAD device OPAL is confirmed in clinical routine and studied in terms of detoxification capabilities, efficacy and efficiency. For the ECAD device ALBUNIQUE, a further developed system requiring less specialised technical equipment, no corresponding literature is available. Methods: This retrospective single-center study included patients undergoing ECAD, either OPAL and/or ALBUNIQUE, in a two-year period from 2023 to 2024, with treatment times of 12 h or more. Generalized Estimating Equations were used to compare the effects of ECAD therapy. Results: In total, n = 25 patients with ECAD treatments were identified in our institution. Among these patients n = 90 ECAD cycles were eligible for evaluation, thereof n = 58 (64%) treatments with OPAL and n = 32 (36%) with ALBUNIQUE. ECAD treatment resulted in significant reduction of bilirubin, ammonia, creatinine, and urea levels as well as significant increase of negative base excess values. The first ECAD cycle was associated with highest percental changes. There were no significant differences between the parameters gathered by OPAL and ALBUNIQUE. Conclusion: Both ECAD systems, OPAL and ALBUNIQUE, were effective in removing bilirubin, reducing ammonia levels, eliminating water-soluble substances and stabilizing metabolic dysfunction without significant differences between the devices. Further, we found no increased bleeding risk during or after application of ECAD treatment in general or for one of the examined devices.