{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T18:27:31Z","timestamp":1788200851033,"version":"build-2803163510"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Hepatic chemosaturation using extracorporeal circulation (ECC) is associated with severe hemodynamic instability. Activated charcoal filters are used to prevent systemic toxicity, but their effects on circulating catecholamines remain poorly understood.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this prospective, single-center observational study, systemic catecholamine concentrations were measured in 15 procedures undergoing hepatic chemosaturation. Blood samples were obtained at predefined time points: after induction of anesthesia (T0), during initiation of ECC (T1), immediately before (T2.1) and after charcoal filtration (T2.2) and after termination of ECC (T3).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Systemic noradrenaline concentrations changed significantly over time (p\u2009<\u20090.001). The measured noradrenaline concentration increased markedly during inferior vena cava occlusion and ECC. This was consistent with pronounced hemodynamic instability and a significant increase in the dose of noradrenaline administered (T1 and T2.1 vs. T0), followed by a near-complete reduction across the activated charcoal filter (median extraction rate 95.5%) with continued high NA administration (median 0.35 \u00b5g\/kg\/min). In contrast, adrenaline and dopamine concentrations remained stable and were neither administered nor significantly affected by filtration. After termination of ECC, a pronounced rebound increase in noradrenaline concentrations was observed. These biochemical changes were accompanied by metabolic acidosis and rising lactate levels.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Activated charcoal filtration during hepatic chemosaturation selectively removes circulating noradrenaline and is a key contributor to perioperative hemodynamic instability. Awareness of this mechanism is essential for tailored vasopressor strategies and safer anesthetic management.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n DRKS,\n DRKS00034527<\/jats:ext-link>\n . Registered 24 June 2024,\n https:\/\/drks.de\/search\/de\/trial\/DRKS00034527<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0350771","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:42:36Z","timestamp":1788198156000},"page":"e0350771","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Activated charcoal filtration profoundly alters systemic noradrenaline concentrations during hepatic chemosaturation: A prospective cohort study"],"prefix":"10.1371","volume":"21","author":[{"given":"Jan","family":"Turra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dania","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osman","family":"\u00d6cal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Biecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Mayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Grieshaber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Folker","family":"Wenzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Karck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Nikolic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maik","family":"von der Forst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Weigand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Ulrich","family":"Kauczor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica Cecile","family":"Hassel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Lichtenstern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0960-038X","authenticated-orcid":true,"given":"Maximilian","family":"Dietrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2559-8390","authenticated-orcid":true,"given":"Patrick","family":"Rehn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"pone.0350771.ref001","doi-asserted-by":"crossref","first-page":"646","DOI":"10.6004\/jnccn.2018.0042","article-title":"New NCCN Guidelines for Uveal Melanoma and Treatment of Recurrent or Progressive Distant Metastatic Melanoma","volume":"16","author":"CA Barker","year":"2018","journal-title":"J Natl Compr Canc Netw"},{"issue":"12","key":"pone.0350771.ref002","doi-asserted-by":"crossref","first-page":"2122","DOI":"10.1007\/s12325-016-0424-4","article-title":"Chemosaturation Percutaneous Hepatic Perfusion: A Systematic Review","volume":"33","author":"A Vogel","year":"2017","journal-title":"Adv Ther"},{"issue":"1","key":"pone.0350771.ref003","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s10585-022-10193-4","article-title":"New perspectives in unresectable cholangiocarcinoma? 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