Molecular adsorbent recirculating system (MARS) application in liver failure: clinical and hemodepurative results in 22 patients.
OBJECTIVE
Acute liver failure (ALF) and acute on chronic liver failure (ACLF) still show a poor prognosis. MARS was used in 22 patients with ALF or ACLF to prolong patient survival for liver function recovery or as a bridge to transplantation.


METHODS
Evaluation of depurative efficiency, biocompatibility, hemodynamics, encephalopathy (HE) and clinical outcome.


METHODS
During 71 five-hour sessions we evaluated (0', 60', 120', 180', 240', 300'): bilirubin, ammonia, cholic acid (CCA), chenodeoxycholic acid (CCDCA), leukocytes, platelets, hemoglobin and mean arterial pressure (MAP). Serum creatinine, electrolytes, cardiac output, cardiac index (bioimpedence) and HE (West Haven Criteria score) were evaluated at 0' and 300'. STATISTICAL METHODS AND OUTCOME MEASURES: Student's t-test for pre- vs. end-session values was used. For bilirubin and ammonia the correlation test was made between pre- and end-session values and between pre-session values and removal rates (RRS).


RESULTS
Survival was 90.9% at 7 days, 40.9% at 30 days. Pre- vs. end-session: bilirubin from 37.2 +/- 12.5 mg/dL to 24.9 +/- 8.9 mg/dL (p < 0.01), ammonia from 88.0 +/- 60.4 micromol/L to 43.6 +/- 32.9 micromol/L (p < 0.01), CCA from 42.8 +/- 21.0 micromol/L 18.2 +/- 9.8 micromol/L (p < 0.01), CCDCA from 26.3 +/- 6.3 micromol/L to 15.7+/-7.6 micromol/L (p<0.01). The correlation test between pre-session values of bilirubin and ammonia vs. RR S was respectively 0.32 (p = 0.01) and 0.30 (p = 0.04). Leukocytes, platelets and hemoglobin remained stable. MAP increased from 82.0 +/- 12.0 mmHg to 87.0 +/- 13.0 mmHg (p < 0.05), West Haven Criteria score decreased from 2.7 +/- 0.7 to 0.7 +/- 0.7 (p < 0.001).


CONCLUSIONS
MARS treatment led in all patients to an improvement of clinical, hemodynamic and neurological conditions, with significant reduction in the hepatic toxins blood level. Treatment biocompatibility and tolerance were satisfactory.
Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, Bologna, Italy. sergio.stefoni@unibo.it
S
S
Stefoni
L
L
Colì
L
L
Bolondi
G
G
Donati
G
G
Ruggeri
G
G
Feliciangeli
F
F
Piscaglia
E
E
Silvagni
M
M
Sirri
G
G
Donati
O
O
Baraldi
M L
ML
Soverini
G
G
Cianciolo
P
P
Boni
D
D
Patrono
E
E
Ramazzotti
R
R
Motta
A
A
Roda
P
P
Simoni
M
M
Magliulo
L C
LC
Borgnino
D
D
Ricci
D
D
Mezzopane
M L
ML
Cappuccilli
D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy; D000328:Adult; D000368:Aged; D000641:Ammonia / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure; D002635:Chenodeoxycholic Acid / Q000097:blood; D019826:Cholic Acid / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000628:therapy; D006801:Humans; D017093:Liver Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016060:Sorption Detoxification; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
D002635:Chenodeoxycholic Acid; D000641:Ammonia; D014508:Urea; D003404:Creatinine; D019826:Cholic Acid; D001663:Bilirubin