title: Molecular absorbent recirculating system for the treatment of acute liver failure in surgical patients.
abstract: The Molecular Adsorbent Recirculating System (MARS) represents an attractive artificial liver support system for the treatment of liver insufficiency. However, neither indications for MARS treatment (i.e., after extended liver resection) nor criteria for discontinuation of therapy have been evaluated. Therefore, we analyzed the clinical data of all our surgical patients who received MARS treatment for acute liver failure (n = 7). The aim of the study was to identify prognostic indicators for survival. Four of 174 patients resected for hepatic malignancy at our institution received a total of 13 MARS treatments. Two additional patients were successfully bridged to orthotopic liver transplantation with seven MARS treatments and one patient was MARS supported after liver transplantation of a steatotic graft with three MARS treatments. Five of the seven patients survived and were dismissed an average of 31 days, ranging from 17 to 47 days, after the final MARS treatment. No technical complications or adverse effects were observed during the MARS treatments. Important prognostic factors for hepatic recovery and survival were indocyanin green plasma disappearance rates greater than 5%/min and an increase in clotting factor V levels after each MARS treatment. We conclude that MARS therapy can be an effective treatment of postoperative liver insufficiency in the surgical hepatobiliary unit.
authors.affiliation: Department of Visceral and Transplant Surgery, University Hospital Bern, Switzerland. daniel.inderbitzin@insel.ch
authors.forename: Daniel
authors.initials: D
authors.lastname: Inderbitzin
authors.forename: Beat
authors.initials: B
authors.lastname: Muggli
authors.forename: Annette
authors.initials: A
authors.lastname: Ringger
authors.forename: Guido
authors.initials: G
authors.lastname: Beldi
authors.forename: Markus
authors.initials: M
authors.lastname: Gass
authors.forename: Beat
authors.initials: B
authors.lastname: Gloor
authors.forename: Dominik
authors.initials: D
authors.lastname: Uehlinger
authors.forename: Bruno
authors.initials: B
authors.lastname: Regli
authors.forename: Jürg
authors.initials: J
authors.lastname: Reichen
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
mesh_terms: D000328:Adult; D000368:Aged; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D017114:Liver Failure, Acute / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016060:Sorption Detoxification / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green