Fulminant hepatic failure bridged to liver transplantation with a molecular adsorbent recirculating system: a single-center experience.
We herein describe the clinical course of a consecutive series of fulminant hepatic failure patients treated with a molecular adsorbent recirculating system (MARS), a cell-free albumin dialysis technique. From November 2000 to September 2002, seven adult patients ages 22-61 (median, 41), one male (14.2%) and six females (85.7%), affected by fulminant hepatic failure underwent seven courses (one to five sessions each, 6 hr in duration) of extracorporeal support using the MARS technique. Pre- and posttreatment blood glucose, liver function tests, ammonia, arterial lactate, electrolytes, hemodynamic parameters, arterial blood gases, liver histology, Glasgow Coma Scale, and coagulation studies were reviewed. No adverse side effects such as generalized bleeding on noncardiogenic pulmonary edema, often seen during MARS treatment, occurred in the patients included in this study. Six patients (85.7%) are currently alive and well, and one (14.2%) died. Four patients (57%) were successfully bridged (two patients in 1 day and two other patients in 4 days) to liver transplantation, while two (5%) recovered fully without transplantation. All the measured variables stabilized after commencement of the MARS. No differences were noted between the pre- and the post-MARS histology. We conclude that the MARS is a safe, temporary life support mechanism for patients awaiting liver transplantation or recovering from fulminant hepatic failure.
Doria
Cataldo
C
Transplant Division, Department of Surgery, Jefferson Medical College-Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA. cataldo.doria@jefferson.edu
Mandalá
Lucio
L
Scott
Victor L
VL
Gruttadauria
Salvatore
S
Marino
Ignazio R
IR
D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017114:Liver Failure, Acute / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016060:Sorption Detoxification; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists