Molecular adsorbents recirculating system treatment in acute-on-chronic hepatitis patients on the transplant waiting list improves model for end-stage liver disease scores.
BACKGROUND
The aim of our study was to show an improvement in Model for End-Stage Liver Disease (MELD) score after treatment with Molecular adsorbents recirculating system (MARS) in acute-on-chronic hepatitis (AoCHF) patients. MELD was adopted to determine the prognosis of patients with liver chronic desease. We evaluated the possibility to improve the MELD score of patients awaiting liver transplantation using a liver support device, namely, MARS.


METHODS
From September 1999 to April 2006, we treated 80 patients whose diagnoses were hepatitis C, 41.25%; hepatitis B, 27.5%; alcholic, 17.5%; intoxication, 8.75%; primary biliary cirrhosis, 5%. The overall mean age was 45 years (23 to 62), the cohort included 56 men and 24 women. Inclusion criteria were bilirubin >15 mg/dL; MELD >20; encephalopathy >II; and International Normalized Ratio, >2.1. Other parameters evaluated included ammonia, creatinine, lactate, glutamic oxalic transminase, and guanosine 5'-triphosphate. All patients were treated with a mean of 6-hour cycles of MARS (range, 5 to 8 hours) for a minimum of three treatments and a maximum of 20 treatments over 3 months. Clinical conditions were evaluated by improved hemodynamic parameters, kidney function, liver function, coagulation, neurologic status using the SOFA score, Glasgow Coma Scale (GCS), and Acute Physiology and Chronic Health Evaluation II Criteria.


RESULTS
The MELD score for all categories of living patients showed significant improvements at the end of treatment and at 3-months follow-up, but the small number of patients was a limitation to determine prediction of mortality.


CONCLUSIONS
Our study shows that MARS treatment improved multiple organ functions-liver, renal, neurologic, and hemodynamic. The improved MELD score gave patients on the transplant waiting list longer survival, allowing them a greater opportunity for liver transplantation.
Novelli
G
G
Dipartimento di Chirurgia Generale specialità chirurgiche e trapianti d'Organo P Stefanini, Universita' Degli Studi di Roma La Sapienza, Rome, Italy. novelligilnardo@virgilio.it
Rossi
M
M
Pugliese
F
F
Poli
I
I
Ruberto
E
E
Martelli
S
S
Nudo
F
F
Morabito
V
V
Mennini
G
G
Berloco
P B
PB
D000208:Acute Disease; D000327:Adsorption; D002908:Chronic Disease; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000601:surgery* / Q000628:therapy*; D019698:Hepatitis C, Chronic / Q000601:surgery* / Q000628:therapy*; D006801:Humans; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology; D008954:Models, Biological; D012189:Retrospective Studies; D016019:Survival Analysis; D014850:Waiting Lists