title: Molecular adsorbent recirculating system treatment for patients with liver failure: the Hong Kong experience.
abstract: 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.
authors.affiliation: Intensive Care Unit, Queen Mary Hospital, Hong Kong, China.
authors.forename: Alexander
authors.initials: A
authors.lastname: Chiu
authors.forename: Lina Mun Yee
authors.initials: LM
authors.lastname: Chan
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
mesh_terms: 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*
chemical_list: D000641:Ammonia; D001663:Bilirubin