title: Outcome from molecular adsorbent recycling system (MARS) liver dialysis following drug-induced liver failure.
abstract: BACKGROUND
  Fulminant liver failure from drug ingestion is associated with a high mortality, and the introduction of liver transplantation has improved the mortality significantly if done in a timely fashion. Recently, molecular adsorbent recycling system (MARS) liver dialysis has been introduced as a support for liver failure with varying results. We review our experience with drug-induced liver failure and the impact of MARS liver dialysis on the outcome, in a setting where cadaveric liver transplantation is rarely available.
  
  
  RESULTS
  A total of 13 patients were treated, and 40 sessions of MARS liver dialysis were conducted in the intensive care unit. The majority of cases were because of herbal medicine toxicity. Total bilirubin, conjugated bilirubin, and delta bilirubin were significantly reduced, with no change in unconjugated bilirubin. All patients satisfied the criteria for urgent liver transplantation with an average Model End Stage Liver Disease (MELD) score of 35. Only one patient received a liver transplantation from a live donor (right lobe). Overall mortality was 85%. Median time-to-death from the start of MARS was 8 days.
  
  
  CONCLUSIONS
  MARS liver dialysis in a setting without timely liver transplantation is associated with a poor outcome. It does, however, provide a window of time for consideration of living donors in the setting of limited cadaveric donors.
authors.affiliation: Department of Medicine, National University Hospital, Lower Kent Ridge Road, Singapore 119074, Singapore. mdcleekh@nus.edu.sg
authors.forename: Kang-Hoe
authors.initials: KH
authors.lastname: Lee
authors.forename: Margaret Kwee-Hiang
authors.initials: MK
authors.lastname: Lee
authors.forename: Dede Selamat
authors.initials: DS
authors.lastname: Sutedja
authors.forename: Seng-Gee
authors.initials: SG
authors.lastname: Lim
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D003956:Dialysis; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D016060:Sorption Detoxification
chemical_list: D001663:Bilirubin