Use of the molecular adsorbent recycling system in the treatment of postoperative hepatic failure and septic multiple organ dysfunction--preliminary results.
OBJECTIVE
Molecular adsorbent recycling system (MARS) has been applied successfully in patients with a variety of liver diseases. However, preliminary results in patients with multiple organ failure (MOF) and sepsis were disappointing, possibly because the number of applied MARS cycles was too low. To determine potential effects of prolonged MARS treatment in patients with postsurgical MOF we evaluated five postoperative patients with acute liver failure and septic multiple organ dysfunction in a retrospective observational study.


METHODS
MARS cycles (13.4+/-1.9) were applied during an average time period of 17.2+/-5.2 days. Fresh frozen plasma, thrombocyte units and blood units were transfused to maintain pre-MARS Quick values and thrombocyte counts, and to keep the hemoglobin concentration above 8 g/dl.


RESULTS
Plasma bilirubin concentrations declined significantly during treatment. In contrast, ammonia concentration remained constant, and parameters of the clotting system (Quick value) did not get better or even worsened (partial thromboplastin time) despite significantly increasing the substitution frequency of coagulatory factors. Due to poor clotting, we observed significant bleeding complications during MARS therapy causing a simultaneous rise in the number of transfused blood units. All patients demonstrated persistent, severe abdominal infection during MARS therapy. After discontinuing MARS treatment because of insufficient efficiency, all patients died of progressive septic organ malfunction.


CONCLUSIONS
Our preliminary findings do not support use of MARS in patients with postoperative hepatic failure and progressive septic multiple organ dysfunction, particularly if the septic focus cannot be eliminated. If MARS is still applied, special attention should be paid to simultaneous clotting disorders and bleeding complications.
Rittler
Peter
P
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilian University, Munich, Germany.
Ketscher
Christian
C
Inthorn
Dietrich
D
Jauch
Karl-Walter
KW
Hartl
Wolfgang H
WH
D018806:APACHE; D000328:Adult; D006801:Humans; D008658:Inactivation, Metabolic; D017114:Liver Failure, Acute / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D019164:Liver, Artificial; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011184:Postoperative Period; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome