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  • Open Access

Experience with the Molecular Adsorbents Recirculating System: Chinese results on 149 patients with liver failure based on hepatitis B

  • 1,
  • 2,
  • 3,
  • 4,
  • 5 and
  • 6
Critical Care20048 (Suppl 1) :P143

https://doi.org/10.1186/cc2610

  • Published:

Keywords

  • Hepatitis
  • Liver Transplantation
  • Liver Failure
  • Prothrombin
  • Prothrombin Time

Introduction

Liver failure resulting from hepatitis B (HBV) represents difficult-to-treat conditions. Molecular Adsorbents Recirculating System (MARS) liver support is a novel therapy, but few data on patients of HBV are available.

Methods

This report is a review of MARS on patients with liver failure suffered from HBV. Data were extracted from official journals until September 2003; 149 patients with 347 treatments in China were eligible with available detailed data (mean age was 44.3 ± 13.2 [15–80] years, 102 males, average treatments 2.33 per patient).

Results

MARS treatments were associated with a significant reduction of albumin-bound toxins and various cytokines, as well as the water-soluble toxins. Most patients showed a positive response to the therapy, proven by an increase in prothrombin time activity and mean arterial pressure, and a decrease in hepatoencephalo-pathy grade and Child–Turcotte–Pugh index significantly.

Eighty-four patients survived in hospital including those alive from the liver transplantation (56.4%). Survival of the acute liver failure, subacute liver failure and acute on chronic liver failure patients were 62.5%, 66.7% and 54.5%, and acute on chronic liver failure patients formed the majority (121/149–81.2%). Patients in end stage presented the largest among the subgroups of acute on chronic liver failure (65/121, 53.7%), and patients in the early and middle stages gained more favorable outcomes than those in C grade (91.7% and 75% vs 30.8%) (Table 1).

Table 1

Type

Total n

Survival n (Re + OLT)

Death n (%)

ALF

16

10 (8 + 2) (62.5%)

6 (37.5%)

SALF

12

8 (8 + 0) (66.7%)

4 (33.3%)

AoCLF

   

   Early stage

24

22 (20 + 2) (91.7%)

2 (8.3%)

   Middle stage

32

24 (21 + 3) (75%)

8 (25%)

   End stage

65

20 (18 + 2) (30.8%)

45 (69.2%)

Total

149

84 (75 + 9) (56.4%)

65 (43.6%)

ALF, acute liver failure; AoCLF, acute on chronic liver failure; OLT, orthotopic liver transplantation; SALF, subacute liver failure.

Randomized controlled studies in China are ongoing to verify the optimal therapeutic results of MARS.

Authors’ Affiliations

(1)
Therapeutic Blood Purification Research Center, University of Rostock, Germany
(2)
Department of Artificial Liver Therapy, South-East University Medical College, Nanjing No. 2 People's Hospital, Nanjing, China
(3)
Hunan Transplantation Medical Center, Central-South University, Changsha, China
(4)
Department of Infectious Diseases, First Affiliated Hospital of Jiangxi Medical College, Nanchang, China
(5)
2ICU & Artificial Liver Support Center, Beijing DiTan Hospital, China
(6)
Institute of Digestive Diseases, Xi'jing Hospital, Fourth Military Medical University, Xi'an, China

Copyright

© BioMed Central Ltd. 2004

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