Use of Molecular Adsorbent Recycling System (MARS) treatment in severe liver failure: initial clinical experience

Introduction

Despite significant advances in intensive care management, patients with severe liver failure (SLF) still have a high mortality rate and the orthotopic liver transplantation (OLT) remains the only effective treatment. Stange et al. [1] have introduced a new, cell-free, extracorporeal, liver assistance method for the selective removal of albumin-bound substances using a specific membrane and an albumin-enriched dialysate, namely Molecular Adsorbent Recycling System (MARS).

Methods

Eleven patients (mean age 46, range 23-71 years; 4 M, 7 F) affected by SLF, admitted to our ICU, were treated with MARS. Seven patients were candidates to OLT, while the other four patients were excluded from the list because of the sepsis. Patients were divided in three groups. Group I was composed of patients (n = 7) with acute exacerbation of chronic liver disease; Group II of patients (n = 3) with acute liver failure and Group III (n = 1) of one patient with delayed nonfunction after OLT. Thirty one MARS sessions, lasting 6 hours each, in addiction to standard therapy, were performed. Laboratory parameters, Fischer's ratio and hepatic encephalopathy (HE) were evaluated before and after each MARS treatment in our three groups.

Results

No hemodynamic variations, technical problems or significant adverse reaction occurred during MARS sessions. In the three groups a statistically significant decrease in total and conjugated bilirubin, ammonia and bile acids levels was observed after MARS (P < 0.01). Bun and creatinine levels markedly decrease (P < 0.01 in Groups I and III; P < 0.05 in Group II). In the three groups HE was successfully reduced at least one point. The Fischer's ratio improved in all groups. Four patients having liver transplantation after MARS showed favourable outcome. One was discharged with improved condition, while six patients died.

Conclusions

MARS seems to be an effective depurative system and could be proposed as a bridge to OLT. Nevertheless, further studies will be necessary to know the optimal timing and favourable indication of MARS in SLF.