Liver failure: basis of benefit of therapy with the molecular adsorbents recirculating system.
Accumulation of albumin-bound toxins is known to occur in liver failure, and to variable extents is responsible for the associated end-organ dysfunctions (kidney, circulation, brain). The toxin-binding and scavenging functions of albumin are exploited in albumin dialysis for removal of these toxins. The extracorporeal liver support device known as molecular adsorbents recirculating system (MARS) is based on dialysis across an albumin-impregnated membrane, using 20% albumin as dialysate. Charcoal and anion exchange resin columns in the circuit help cleanse and regenerate the dialysate. Clinical studies over the last few years have demonstrated proven reduction in hyperbilirubinaemia, along with an improvement in encephalopathy, systemic haemodynamics and renal function in liver failure patients, as well as apparent improvement in survival. The results of larger controlled clinical trials, as well as studies investigating the pathophysiological basis of its effect, are awaited.
Sen
Sambit
S
Institute of Hepatology, University College London, 69-75 Chenies Mews, London, WC1E 6HX, UK.
Jalan
Rajiv
R
Williams
Roger
R
D000418:Albumins / Q000627:therapeutic use*; D006801:Humans; D017093:Liver Failure / Q000503:physiopathology / Q000628:therapy*; D012709:Serum Albumin / Q000502:physiology*; D016060:Sorption Detoxification / Q000379:methods*
D000418:Albumins; D012709:Serum Albumin