Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis.
OBJECTIVE
The mortality of patients with severe acute alcoholic hepatitis (AH) remains high, leading to interest in the use of extracorporeal liver support. The molecular adsorbents recirculating system (MARS) is a liver support device based upon a hollow fibre module in which the patient's blood is dialyzed across an albumin-impregnated membrane. The aim of this paper is to assess the safety, efficacy and feasibility of using MARS in patients with severe AH.


METHODS
Eight patients (all encephalopathic; hepatorenal syndrome: Type 1, five patients; Type 2, two patients) were treated with MARS. Clinical, biochemical and haemodynamic assessments were done.


RESULTS
Five patients were discharged from hospital, and four are alive at 3 months of follow-up, compared with an estimated survival of about 20%. There were significant improvement in serum bilirubin (P=0.008), creatinine (P=0.02), prothrombin time (P=0.04), and grade of encephalopathy (P=0.05). Sustained improvements in mean arterial pressure, systemic vascular resistance and cardiac output were observed. Thrombocytopaenia was the only MARS-related adverse event observed.


CONCLUSIONS
MARS resulted in improved liver biochemistry, cardiovascular haemodynamics, renal function and encephalopathy in patients with severe AH, with an apparent reduction in mortality. On this basis, a multi-centre, randomized clinical trial has been initiated.
Jalan
Rajiv
R
Liver Failure Group, Institute of Hepatology, University College London Medical School and University College London Hospitals, 69-75 Chenies Mews, London WC1E 6HX, UK. r.jalan@ucl.ac.uk
Sen
Sambit
S
Steiner
Christian
C
Kapoor
Dharmesh
D
Alisa
Akeel
A
Williams
Roger
R
D000208:Acute Disease; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure; D002302:Cardiac Output; D003404:Creatinine / Q000097:blood; D005240:Feasibility Studies; D006501:Hepatic Encephalopathy / Q000503:physiopathology; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011517:Prothrombin Time; D012720:Severity of Illness Index; D016060:Sorption Detoxification / Q000009:adverse effects; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000209:etiology; D014655:Vascular Resistance
D003404:Creatinine; D001663:Bilirubin