Molecular adsorbent recirculating system: a clinical experience in acute or acute on chronic liver failure (133 sessions)

Introduction

The molecular adsorbent recirculating system (MARS; Teraklin Industry, Rostock, Germany) is an extracorporeal acute liver failure support system method using albumin-enriched dialysate to remove albumin-bound toxins.

Methods

Between 2004 and 2007, we performed 133 MARS treatments in 46 patients: Sequential Organ Failure Assessment score 11.8 ± 4.5. Indication for MARS included 16 cases of fulminant hepatic failure, 21 cases of acute failure on cirrhosis, one intractable pruritus, eight moderate or severe acute liver failure (Bernuau criteria). Among all these patients, 16 had acute renal failure (hepatorenal syndrome). It was a retrospective study. All data were recorded before (T0) and at the end of MARS treatment (T).

Results

Among 16 fulminant hepatic failure patients, we observed a significant decrease of encephalopathy (P = 0.04). On the other hand we did not observe significant improvement of hemodynamic parameters (norepinephrine dose, mean arterial pressure), metabolic parameters (pH, lactate) or hepatic tests (aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, prothrombin time, factor V). In this subgroup, hospital mortality is 31% at day 28. In the group treated for acute on chronic liver failure, the results did not show a difference between grade of encephalopathy before and after the session. We only observed a trend of improvement in hemodynamic and biologic parameters but this was not statistically significant except for cholestase parameters (γ-glutamyltransferase P = 0.022, bilirubin P = 0.002). Hospital mortality is 71% at day 28. Among the patients with hepatorenal syndrome, 62.5% were anuric. We observed a significant increase of diuresis output (P < 0.01). We did not observe any significant adverse event.

Conclusion

Our results confirmed that nonbiologic hepatic support by MARS was safe. The results were disappointing above all in cirrhosis patients. Nevertheless, results in hepatorenal syndrome were encouraging.