The Molecular Adsorbent Recirculating System in patients with severe liver failure: clinical results at the K.U. Leuven.
BACKGROUND
The Molecular Adsorbent Recirculating System (MARS) is a novel extracorporeal technique for liver support. We report the clinical results in the first 13 patients with severe liver failure treated at our institution.


METHODS
Patients with acute or acute on chronic liver failure of various aetiologies were treated with varying numbers of MARS sessions of six hours duration.


RESULTS
Mean APACHE II score was 18. In general, patients with multiple organ failure faired poorly even with MARS treatment. Five patients (38%) survived the hospitalisation. Eight patients (62%) fulfilled criteria for UNOS type I or 2 A status. Two of these patients survived. Five patients had a UNOS 2B status and three survived. In proportion, patients with severe itch, patients with primary non-function and those where MARS was used as a bridge to transplantation seemed to profit most from the treatment. The median reduction in bilirubin concentrations after the treatment period was -28.2%. In survivors, the median reduction was -37.7% and in patients who died was -15.9%. The median encephalopathy score improved from 1.7 to 0.5.


CONCLUSIONS
The molecular adsorbent recycling system (MARS) might be lifesaving in patients with severe liver failure of different aetiologies.
Wilmer
Alexander
A
Medical Intensive Care Unit, UZ Gasthuisberg, Catholic University of Leuven, Belgium. alexander.wilmer@uz.kuleuven.ac.be
Nevens
Frederik
F
Evenepoel
Pieter
P
Hermans
Greet
G
Fevery
Johan
J
D000328:Adult; D000368:Aged; D005260:Female; D006501:Hepatic Encephalopathy / Q000401:mortality / Q000628:therapy; D006801:Humans; D017114:Liver Failure, Acute / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012720:Severity of Illness Index; D016060:Sorption Detoxification; D016019:Survival Analysis; D016896:Treatment Outcome