title: Role of the molecular adsorbent recycling system (MARS) in the treatment of patients with acute exacerbation of chronic liver failure.
abstract: OBJECTIVE
  To test the efficacy of the molecular adsorbent recycling system (MARS) in patients with acute exacerbation of chronic liver disease.
  
  
  METHODS
  A prospective case analysis.
  
  
  METHODS
  A university-affiliated tertiary medical center.
  
  
  METHODS
  We applied MARS to treat a consecutive series of eight patients with acute exacerbation of chronic liver disease.
  
  
  RESULTS
  The overall survival rate was 62.5%. All patients demonstrated improvement with regard to their degree of encephalopathy. In three patients, intracranial pressure and jugular bulb oxygen saturation decreased and cerebral perfusion pressure increased after treatment institution. Patients' hyperdynamic state was attenuated, as demonstrated by elevation of systemic vascular resistance, mean arterial pressure, and parallel reduction in cardiac index. A prompt reduction in serum ammonia, bilirubin, and lactate levels was observed. There were no complications during the treatment period.
  
  
  CONCLUSIONS
  Applying MARS treatments to patients with acute exacerbation of chronic liver disease can detoxify blood, improve cerebral circulation, and reduce brain edema, as reflected by the reduction in intracranial pressure and jugular bulb oxygen saturation values in our patients. A partial reversal of the characteristic hyperdynamic circulation was also achieved. Despite our encouraging results, further testing is needed to determine the reliability of the system.
authors.affiliation: General Intensive Care Unit, the Department of Surgery B and the Liver Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. sorkine@tasmc.health.gov.il
authors.forename: P
authors.initials: P
authors.lastname: Sorkine
authors.forename: R
authors.initials: R
authors.lastname: Ben Abraham
authors.forename: O
authors.initials: O
authors.lastname: Szold
authors.forename: P
authors.initials: P
authors.lastname: Biderman
authors.forename: A
authors.initials: A
authors.lastname: Kidron
authors.forename: H
authors.initials: H
authors.lastname: Merchav
authors.forename: S
authors.initials: S
authors.lastname: Brill
authors.forename: R
authors.initials: R
authors.lastname: Oren
mesh_terms: D000327:Adsorption; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006439:Hemodynamics; D006501:Hepatic Encephalopathy / Q000097:blood / Q000401:mortality / Q000628:therapy; D006801:Humans; D007557:Israel / Q000453:epidemiology; D017093:Liver Failure / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D015996:Survival Rate
chemical_list: D008567:Membranes, Artificial