title: MARS: a futile tool in centres without active liver transplant support.
abstract: OBJECTIVE
  Studies on Molecular Adsorbent Recycling Systems (MARS) showed inconclusive survival benefits.
  
  
  METHODS
  We evaluated the efficacy of MARS for patients with either acute liver failure (ALF) or acute-on-chronic liver failure (AoCLF) at our centre, from February 2002 till April 2006 retrospectively.
  
  
  RESULTS
  Fifty ALF patients underwent median (range) three (1-10) sessions of MARS. Acute exacerbations of chronic hepatitis B (n=26) and drug-induced liver injury (n=12) were the commonest causes. Living donors were available in 6, 2 paediatric patients underwent left lobe and four adults underwent right lobe living donor liver transplant. Among the 44 ALF patients without a suitable living donor, one underwent deceased donor liver transplant and survived, another 19-year-old male with acute exacerbations of chronic hepatitis B recovered without transplant, and the rest died. Twenty-six had AoCLF and underwent four (1-10) MARS sessions. Sepsis (n=16) and upper gastrointestinal bleeding (n=4) were the commonest precipitating factors. None had a suitable living or deceased donor, suitable for transplantation during their hospitalization. Only one of 26 AoCLF patients survived the hospitalization, but the survivor died of sepsis 1 month later.
  
  
  CONCLUSIONS
  In this non-randomized study, survival after MARS was related to the availability of transplant, and in patients where living or deceased donor transplant was unavailable, MARS was of little benefit. Randomized-controlled trials on MARS((R)) are urgently needed to clarify its clinical utility.
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. mdcwt@nus.edu.sg
authors.forename: Chun-Tao
authors.initials: CT
authors.lastname: Wai
authors.forename: Seng-Gee
authors.initials: SG
authors.lastname: Lim
authors.forename: Myot-Oo
authors.initials: MO
authors.lastname: Aung
authors.forename: Yin-Mei
authors.initials: YM
authors.lastname: Lee
authors.forename: Dede S
authors.initials: DS
authors.lastname: Sutedja
authors.forename: Yock-Young
authors.initials: YY
authors.lastname: Dan
authors.forename: Marion M
authors.initials: MM
authors.lastname: Aw
authors.forename: Seng-Hock
authors.initials: SH
authors.lastname: Quak
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Lee
authors.forename: Maureen
authors.initials: M
authors.lastname: Da Costa
authors.forename: K
authors.initials: K
authors.lastname: Prahbakaran
authors.forename: Kang-Hoe
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000628:therapy*; D016031:Liver Transplantation; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged