Mars and Prometheus: our clinical experience in acute chronic liver failure.
BACKGROUND
In our clinical context, there are two groups that practice blood purification treatments on acute or chronic liver failure (AoCLF) patients: one group used MARS (molecular adsorbent recirculating system) and the other Prometheus.


METHODS
The MARS group used the lack of response to standard medical treatment after 72 hours of observation as the access criterion. The Prometheus group used the access criteria of the multicenter Helios protocol for patients in AoCLF, as well as those with primary nonfunction (PNF) and secondary liver insufficiency. Both groups performed treatment sessions of at least 6 hours, which were repeated at least every 24 to 36 hours.


RESULTS
The 56 treated AoCLF patients underwent 278 treatment sessions; 41 out of 191 procedures with MARS and 16 out of 87 procedures with prometheus, which was also applied in two cases in PNF and four in secondary liver insufficiency. The results showed that both systems accomplished a good purification efficiency and that application to patients enabled reinstatement on the transplant list and grafts in 70% of the cases with either method.


CONCLUSIONS
Treatment led to recovery in dysfunction among patients not destined for transplantation, achieved with a 48.5% 3-month survival in the MARS group and 33.5% in the Prometheus groups. The treatment results were inversely proportional to the MELD at the time of entry; The treatment appeared to be pointless. Among PNF and secondary liver insufficiency cases.
Department of Surgery, Intensive Care and Transplantation, Policlinico Sant'Orsola, Bologna, Italy. stefano.faenza@unibo.it
S
S
Faenza
O
O
Baraldi
M
M
Bernardi
L
L
Bolondi
L
L
Coli
A
A
Cucchetti
G
G
Donati
F
F
Gozzetti
A
A
Lauro
E
E
Mancini
A D
AD
Pinna
F
F
Piscaglia
L
L
Rasciti
M
M
Ravaioli
G
G
Ruggeri
A
A
Santoro
S
S
Stefoni
D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000209:etiology; D002908:Chronic Disease; D006501:Hepatic Encephalopathy / Q000517:prevention & control; D006801:Humans; D017093:Liver Failure; D017114:Liver Failure, Acute / Q000097:blood / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008875:Middle Aged; D016060:Sorption Detoxification / Q000379:methods*; D014850:Waiting Lists