title: Catholic university experience with molecular adsorbent recycling system in patients with severe liver failure.
abstract: OBJECTIVE
  Molecular adsorbent recycling system (MARS) treatment is able to remove both hydrosoluble and small- and medium-sized lipophilic toxins. MARS plays an important role in modifying liver failure complications, such as hepatorenal syndrome and hepatic encephalopathy. We sought to evaluate the clinical efficacy and safety of a MARS device in a consecutive series of hepatic failure patients.
  
  
  METHODS
  Twenty patients with acute liver failure, transplantation failure, or acute on chronic liver failure fulfilled the inclusion criteria of total bilirubin > or =10 mg/dL and at least one of the following: hepatic encephalopathy (HE) > or =II grade, hepatorenal syndrome (HRS) for chronic patients or total bilirubin > or =5 mg/dL and HE > or =I grade for acute patients.
  
  
  RESULTS
  MARS was able to reduce cholestatic parameters and improve neurologic status and renal function parameters in all treated patients. We also observed an improvement in the 3-month survival rate compared to the expected outcome in patients with MELD scores between 20 and 29, as well as 30 and 39.
  
  
  CONCLUSIONS
  Based on these results, we confirm the safety and clinical efficacy of MARS treatment, with the best results in patients with MELD score of 20 to 29. Further studies are necessary to confirm whether this treatment is able to modify patient outcomes and prognosis.
authors.affiliation: Department of Medical Pathology, Catholic University of Rome, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Di Campli
authors.forename: M C
authors.initials: MC
authors.lastname: Santoro
authors.forename: R
authors.initials: R
authors.lastname: Gaspari
authors.forename: G
authors.initials: G
authors.lastname: Merra
authors.forename: L
authors.initials: L
authors.lastname: Zileri Dal Verme
authors.forename: M A
authors.initials: MA
authors.lastname: Zocco
authors.forename: A C
authors.initials: AC
authors.lastname: Piscaglia
authors.forename: G
authors.initials: G
authors.lastname: Di Gioacchino
authors.forename: M
authors.initials: M
authors.lastname: Novi
authors.forename: A
authors.initials: A
authors.lastname: Santoliquido
authors.forename: R
authors.initials: R
authors.lastname: Flore
authors.forename: P
authors.initials: P
authors.lastname: Tondi
authors.forename: R
authors.initials: R
authors.lastname: Proietti
authors.forename: G
authors.initials: G
authors.lastname: Gasbarrini
authors.forename: P
authors.initials: P
authors.lastname: Pola
authors.forename: A
authors.initials: A
authors.lastname: Gasbarrini
mesh_terms: D001663:Bilirubin / Q000097:blood; D002908:Chronic Disease; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006501:Hepatic Encephalopathy / Q000628:therapy; D006530:Hepatorenal Syndrome / Q000628:therapy; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017114:Liver Failure, Acute / Q000209:etiology / Q000401:mortality / Q000628:therapy; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016060:Sorption Detoxification / Q000379:methods; D016019:Survival Analysis
chemical_list: D001663:Bilirubin