Molecular adsorbent recirculating system in patients with acute liver failure: prospective follow-up

Introduction

A prospective observational study on molecular adsorbent recirculating system (MARS) therapy in a liver-disease-dedicated ICU.

Methods

From January 2004 to November 2009, all patients with an acute liver failure fulfilling MARS therapy criteria, in relation to two main indications: primary and secondary to chronic liver failure (ALF/ACLF = group 1) or intractable pruritus (IP = group 2), were included: Data were collected before and after each MARS procedure. APACHE and MELD scores [1] were used to predict the ICU mortality and the 90-day mortality, respectively.

Results

Thirty-nine patients, APACHE II = 41 (21 to 86); MELD = 29 (14 to 47), having received 98 treatments (one to five treatments), were included. The overall mortality was n = 22 (56%). Since 35 patients have been treated for ALF/ACLF, 15 underwent a liver transplantation (OLT) (see Figure 1). The 90-day mortality of the 20 patients from group 1 without OLT was 44%, compared with 76% predicted by the MELD score. MARS was effective to decrease the bilirubin levels -35% (of the pretreatment rate which was 30 times the baseline), P < 0.01, the ammoniemia levels -50% (of the pretreatment rate which was four times the baseline), P < 0.01, and serum creatinine levels -40% (of the pretreatment rate which was two times the baseline). The MARS therapy was also effective to improve the pruritus after two treatments in the group 2 patients. A single severe complication was noticed as hemorrhagic shock quickly resolved in one patient (group 1).

Figure 1

Three-month outcome.

Conclusions

MARS therapy improves liver function in patients with both acute and chronic liver failure, and allows those patients to wait until OLT, if necessary. Furthermore it also improves the 90-day survival of patients with ACLF having no OLT indication.