title: Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation.
abstract: OBJECTIVE
  To assess the usefulness of dialysis with the molecular adsorbent recirculating system (MARS) in patients with acute liver failure who fulfil criteria for liver transplantation.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  ICU at a liver transplantation centre.
  
  
  METHODS
  Twenty-two patients (23 episodes) received MARS dialysis. They were either listed for LT (n=14), delayed (n=1), or not listed (contra-indication, n=7).
  
  
  METHODS
  A total of 56 MARS treatments (median per patient 2; mean duration 7.6+/-2.6h) were performed on haemodialysis.
  
  
  RESULTS
  Clinical and biological variables were assessed before and 24[Symbol: see text]h after MARS therapy. The rate of recovery of liver function without transplantation was compared with an expected rate and survival was analysed. Following MARS dialysis, we observed an improvement in the grade of hepatic encephalopathy (P=0.02) and the Glasgow coma score (P=0.02), a decrease in conjugated bilirubin (P=0.05) and INR (P=0.006), and an increase in prothrombin index (P=0.005). Overall, liver function improved in seven patients (32%): four listed patients in whom transplantation could be avoided and three patients among those not listed due to contra-indications. The transplant-free recovery rate in listed patients was 29% (vs. expected 9%, P=0.036). Listed patients (n=14) had a higher 30-day survival rate [86% (12/14) vs 38% (3/8), P=0.05] and a higher long-term survival rate (P=0.02).
  
  
  CONCLUSIONS
  A statistically significant improvement of liver function was observed after MARS therapy. Transplant-free recovery was more frequent than expected. The apparent benefit of MARS dialysis to treat acute liver failure needs to be confirmed by a controlled study.
authors.affiliation: Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, rue Henri Le Guilloux, CHRU, 2, 35033, Rennes Cedex, France. christophe.camus@chu-rennes.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Camus
authors.forename: Sylvain
authors.initials: S
authors.lastname: Lavoué
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gacouin
authors.forename: Yves
authors.initials: Y
authors.lastname: Le Tulzo
authors.forename: Richard
authors.initials: R
authors.lastname: Lorho
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjéma
authors.forename: Christian
authors.initials: C
authors.lastname: Jacquelinet
authors.forename: Rémi
authors.initials: R
authors.lastname: Thomas
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000628:therapy*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016060:Sorption Detoxification / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome