{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T22:04:54Z","timestamp":1757628294663,"version":"3.44.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Klinikum der Universit\u00e4t M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The treatment of critically ill patients in intensive care units is becoming increasingly complex. For example, organ transplants are regularly carried out, the recipients are seriously ill, and the postoperative course can be complicated. This is why organ replacement and hemadsorption procedures are becoming increasingly important. Adsorption processes are used for specific indications, such as hyperinflammation, hepatic dysfunction, or rhabdomyolysis, in critically ill patients. Nevertheless, there is still a knowledge gap in terms of safety, interactions, and application. This case report provides an example of the thought process that went into deciding whether to apply an adsorption process, as well as other necessary treatment modifications resulting from the application.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case presentation<\/jats:title>\n            <jats:p>We present the case of a 26-year-old Italian man with a complicated postoperative period after lung transplant with the need of organ support systems and hemadsorption therapy. Besides operative difficulties of the transplant and massive bleeding, the patient developed a severe liver failure of unknown origin with highly elevated bile acids, which indicated the use of the CytoSorb<jats:sup>\u00ae<\/jats:sup> cytokine adsorber. Since there are indications that undesired drug elimination may occur and that saturation kinetics have not yet been comprehensively investigated, there were a number of aspects to consider during application. For example, the patient received additional vancomycin dosing and vancomycin blood levels were monitored. Further, to avoid premature saturation of the adsorber, the cartridge was changed every 8\u00a0hours. These adjustments resulted in a continuous reduction in bile acids while maintaining stable vancomycin blood levels, which is critical in immunosuppressed patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The report focuses on two main aspects regarding a safe and sufficient usage of CytoSorb<jats:sup>\u00ae<\/jats:sup> in the intensive care medicine. First, shortened changing periods increase the elimination rate of the adsorber, which is quickly saturated by bigger molecules, for example, bile acids. Second, additional vancomycin dosing during CytoSorb<jats:sup>\u00ae<\/jats:sup> application avoids under dosing since CytoSorb<jats:sup>\u00ae<\/jats:sup> eliminates vancomycin.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13256-025-05503-9","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T08:33:42Z","timestamp":1757406822000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges in the use of the CytoSorb\u00ae adsorber in an intensive care patient with liver dysfunction of unknown origin: a case report"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4580-5630","authenticated-orcid":false,"given":"Caroline","family":"Gr\u00e4fe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Paal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Irlbeck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uwe","family":"Liebchen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Scharf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Graf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"5503_CR1","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1016\/j.athoracsur.2022.08.047","volume":"116","author":"EJ Hyzny","year":"2023","unstructured":"Hyzny EJ, Chan EG, Malik SM, Morrell M, Furukawa M, Ryan JP, et al. Risk factors and outcomes of postoperative hepatic dysfunction after lung transplantation. Ann Thorac Surg. 2023;116:1277\u201384.","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"5503_CR2","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1007\/s00134-018-5464-6","volume":"45","author":"EC Poli","year":"2019","unstructured":"Poli EC, Rimmele T, Schneider AG. Hemoadsorption with CytoSorb((R)). Intensive Care Med. 2019;45(2):236\u20139.","journal-title":"Intensive Care Med"},{"issue":"6","key":"5503_CR3","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12062258","volume":"12","author":"M Popescu","year":"2023","unstructured":"Popescu M, David C, Marcu A, Olita MR, Mihaila M, Tomescu D. Artificial liver support with CytoSorb and MARS in liver failure: a retrospective propensity matched analysis. J Clin Med. 2023;12(6): 2258.","journal-title":"J Clin Med"},{"key":"5503_CR4","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s10047-023-01409-9","volume":"27","author":"I Riva","year":"2023","unstructured":"Riva I, Marino A, Valetti TM, Marchesi G, Fabretti F. Extracorporeal liver support techniques: a comparison. J Artif Organs. 2023;27:261\u20138.","journal-title":"J Artif Organs"},{"key":"5503_CR5","unstructured":"Cytosorb\u00ae. Cytosorb\u00ae Technische Daten 2023 [Available from: https:\/\/cytosorb-therapy.com\/de\/der-adsorber\/technische-daten-des-cytosorb-adsorber\/."},{"issue":"5","key":"5503_CR6","doi-asserted-by":"publisher","first-page":"205","DOI":"10.5301\/ijao.5000591","volume":"40","author":"KS Houschyar","year":"2017","unstructured":"Houschyar KS, Pyles MN, Rein S, Nietzschmann I, Duscher D, Maan ZN, et al. Continuous hemoadsorption with a cytokine adsorber during sepsis\u2014a review of the literature. Int J Artif Organs. 2017;40(5):205\u201311.","journal-title":"Int J Artif Organs"},{"key":"5503_CR7","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s13613-022-01017-5","volume":"12","author":"C Scharf","year":"2022","unstructured":"Scharf C, Weinelt F, Schroeder I, Paal M, Weigand M, Zoller M, et al. Does the cytokine adsorber CytoSorb((R)) reduce vancomycin exposure in critically ill patients with sepsis or septic shock? A prospective observational study. Ann Intensive Care. 2022;12:44.","journal-title":"Ann Intensive Care"},{"key":"5503_CR8","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1186\/s13054-023-04492-9","volume":"27","author":"S Becker","year":"2023","unstructured":"Becker S, Lang H, Vollmer Barbosa C, Tian Z, Melk A, Schmidt BMW. Efficacy of CytoSorb\u00ae: a systematic review and meta-analysis. Crit Care. 2023;27:215.","journal-title":"Crit Care"},{"key":"5503_CR9","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1159\/000527774","volume":"200","author":"G Klinkmann","year":"2023","unstructured":"Klinkmann G, Koball S, Reuter DA, Mitzner S. Hemoperfusion with CytoSorb\u00ae: current knowledge on patient selection, timing, and dosing. Contrib Nephrol. 2023;200:17\u201324.","journal-title":"Contrib Nephrol"},{"key":"5503_CR10","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1186\/s13613-023-01198-7","volume":"13","author":"A Greimel","year":"2023","unstructured":"Greimel A, Habler K, Gr\u00e4fe C, Maciuga N, Brozat CI, Vogeser M, et al. Extracorporeal adsorption of protective and toxic bile acids and bilirubin in patients with cholestatic liver dysfunction: a prospective study. Ann Intensive Care. 2023;13:110.","journal-title":"Ann Intensive Care"},{"key":"5503_CR11","doi-asserted-by":"publisher","first-page":"E563","DOI":"10.1111\/ctr.12197","volume":"27","author":"T Weig","year":"2013","unstructured":"Weig T, Irlbeck M, Frey L, Zwi\u00dfler B, Winter H, Preissler G, et al. Parameters associated with short- and midterm survival in bridging to lung transplantation with extracorporeal membrane oxygenation. Clin Transplant. 2013;27:E563\u201370.","journal-title":"Clin Transplant"},{"key":"5503_CR12","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1007\/s00134-021-06487-y","volume":"47","author":"U Liebchen","year":"2021","unstructured":"Liebchen U, Scharf C, Zoller M, Weinelt F, Kloft C. No clinically relevant removal of meropenem by cytokine adsorber CytoSorb(\u00ae) in critically ill patients with sepsis or septic shock. Intensive Care Med. 2021;47:1332\u20133.","journal-title":"Intensive Care Med"},{"key":"5503_CR13","volume":"4","author":"J Scheier","year":"2022","unstructured":"Scheier J, Nelson PJ, Schneider A, Colombier S, Kindgen-Milles D, Deliargyris EN, Nolin TD. Mechanistic considerations and pharmacokinetic implications on concomitant drug administration during CytoSorb therapy. Crit Care Explor. 2022;4: e0688.","journal-title":"Crit Care Explor"},{"key":"5503_CR14","doi-asserted-by":"publisher","first-page":"1258661","DOI":"10.3389\/fmed.2023.1258661","volume":"10","author":"B Leber","year":"2023","unstructured":"Leber B, Liebchen U, Rohrhofer L, Weber J, Klaus T, Scheier J, Sucher R, Stiegler P. Pharmacokinetics of immunosuppressive agents during hemoperfusion in a sheep model. Front Med (Lausanne). 2023;10:1258661.","journal-title":"Front Med (Lausanne)"},{"key":"5503_CR15","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1111\/aor.13952","volume":"45","author":"AM Scandroglio","year":"2021","unstructured":"Scandroglio AM, Pieri M, Nardelli P, Fominskiy E, Calabro MG, Melisurgo G, et al. Impact of CytoSorb on kinetics of vancomycin and bivalirudin in critically ill patients. Artif Organs. 2021;45:1097\u2013103.","journal-title":"Artif Organs"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-025-05503-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-025-05503-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-025-05503-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T06:50:50Z","timestamp":1757487050000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-025-05503-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,8]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["5503"],"URL":"https:\/\/doi.org\/10.1186\/s13256-025-05503-9","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,8]]},"assertion":[{"value":"17 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The patient\u2019s informed consent to the publication of the case was obtained.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"CS got speaker fees from CytoSorbents Europe GmbH. UL received consulting fees from CytoSorbents Europe GmbH and was part of an advisory board of Roche Diagnostics International Ltd.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"440"}}