Molecular adsorbent recirculating system treatment for patients with liver failure: the Hong Kong experience.
BACKGROUND
The molecular adsorbent recirculating system (MARS) is an extracorporeal liver dialysis system that allows selective removal of bilirubin and other albumin-bound toxins. We reported here our experience with the use of this technique for management of liver failure at Queen Mary Hospital, Hong Kong.


METHODS
From December 2002 to 2004, a total of 74 MARS sessions were performed on 22 patients. The cause of liver failure included acute liver failure (n = 2), acute on chronic liver failure (n = 12), posthepatectomy liver failure (n = 4), and posttransplantation allograft failure (n = 4).


RESULTS
MARS treatment showed significant reduction in total bilirubin level, serum ammonia level and blood urea, and nitrogen (P < 0.001 for all three parameters). Five patients (22.7%) were able to bridge to transplantation and one patient (4.5%) made a spontaneous recovery. The 30-day mortality rate was 72.7%.


CONCLUSIONS
Our results indicated that MARS can effectively improve serum biochemistry and is suitable for temporarily supporting patients with liver failure where transplantation is not immediately available. There is, however, no clear evidence showing that MARS can increase survival, improve the chance of transplantation or assist liver regeneration. Future studies in the form of randomized-controlled trials are crucial to characterize the true potential of this treatment.
Chiu
Alexander
A
Intensive Care Unit, Queen Mary Hospital, Hong Kong, China.
Chan
Lina Mun Yee
LM
Fan
Sheung Tat
ST
D000328:Adult; D000368:Aged; D000641:Ammonia / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001806:Blood Urea Nitrogen; D005260:Female; D006498:Hepatectomy; D006501:Hepatic Encephalopathy / Q000628:therapy; D006723:Hong Kong; D006801:Humans; D017093:Liver Failure / Q000097:blood / Q000401:mortality / Q000628:therapy*; D017114:Liver Failure, Acute / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012449:Safety; D016060:Sorption Detoxification / Q000379:methods*
D000641:Ammonia; D001663:Bilirubin