Artificial liver support system in acute liver failure patients waiting liver transplantation.
OBJECTIVE
To assess the efficacy of the Molecular Adsorbent Recirculating System MARS (GAMBRO LUNDIA AB, Europe) in patients with acute liver failure waiting for liver transplantation.


METHODS
Case-control study in a medical-surgical ICU of a referral hospital. Patients admitted to ICU with severe acute liver failure of any etiology were included. Conventional treatment was applied in all cases according to patient's clinical condition. Patients were treated with MARS after the implementation of this therapy in the ICU. Patients without this treatment were the control group.


RESULTS
Were included 45 patients (control group: 26, MARS group: 19). Comparison between groups showed only differences in plasma bilirrubin levels in the first 24 hours. ICU mortality was 52.63% in the treatment group and 42.3% in the control group (p = 0.49). In the control group 17 patients (65.4%) received a liver transplant and 11 (57.9%) in the MARS group. ICU mortality was lower for transplanted patients in the study group (27.27% vs. 87.5%) (p = 0.019). Kaplan-Meier survival curves indicate that MARS-treated patients before liver transplantation had better survival.


CONCLUSIONS
Combination therapy with MARS and liver transplantation seems to be the more effective therapeutic option for patients with severe ALF.
Montejo González
Juan C
JC
Intensive Care Department, Hospital Universitario 12 de Octubre Madrid, Spain. jmontejo@telefonica.net
Catalán González
Mercedes
M
Meneu Díaz
Juan C
JC
Moreno Elola-Olaso
Almudena
A
De la Cruz
Javier
J
Moreno González
Enrique
E
D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000628:therapy*; D008111:Liver Function Tests; D016031:Liver Transplantation; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome