MARS: a futile tool in centres without active liver transplant support.
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.
Wai
Chun-Tao
CT
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. mdcwt@nus.edu.sg
Lim
Seng-Gee
SG
Aung
Myot-Oo
MO
Lee
Yin-Mei
YM
Sutedja
Dede S
DS
Dan
Yock-Young
YY
Aw
Marion M
MM
Quak
Seng-Hock
SH
Lee
Margaret K
MK
Da Costa
Maureen
M
Prahbakaran
K
K
Lee
Kang-Hoe
KH
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