Molecular adsorbent recycling system (MARS): clinical results of a new membrane-based blood purification system for bioartificial liver support.
The use of xenogenic or genetically engineered cell types in bioartificial liver support systems requires separation methods between the patients' blood and the liver support bioreactors that guarantee the sufficient transfer of pathophysiologically relevant substances but prevent complications. The present paper describes a new membrane separation system that is nearly impermeable to proteins but enables the exchange of water soluble and protein bound toxins by a special membrane and a recycled protein containing dialysate. Because the full range of toxins in hepatic failure has still not been identified, the value of this membrane separation method was evaluated clinically. Thirteen patients suffering from life threatening hepatic failure who had not responded to state of the art therapy were treated with this device, the molecular adsorbent recycling system (MARS). The overall survival rate was 69%. All patients showed positive response to the therapy, indicating that the presented membrane separator combines therapeutic effectivity with the highest safety criteria for the patient by cutting the exchange of substances below the level of proteins.
Stange
J
J
Department of Surgery, Eberhard-Karls-University Tübingen, Germany.
Mitzner
S R
SR
Risler
T
T
Erley
C M
CM
Lauchart
W
W
Goehl
H
H
Klammt
S
S
Peszynski
P
P
Freytag
J
J
Hickstein
H
H
Löhr
M
M
Liebe
S
S
Schareck
W
W
Hopt
U T
UT
Schmidt
R
R
D000327:Adsorption; D000328:Adult; D000641:Ammonia / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002802:Cholinesterases / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000401:mortality / Q000628:therapy; D006801:Humans; D017093:Liver Failure / Q000097:blood / Q000401:mortality / Q000628:therapy*; D019164:Liver, Artificial; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011485:Protein Binding; D006435:Renal Dialysis / Q000379:methods*; D012709:Serum Albumin / Q000378:metabolism; D015996:Survival Rate; D014508:Urea / Q000097:blood
D008567:Membranes, Artificial; D012709:Serum Albumin; D000641:Ammonia; D014508:Urea; D003404:Creatinine; D002802:Cholinesterases; D001663:Bilirubin