[Usefulness and safety of extracorporeal liver support therapy using MARSR for patients with liver failure: a preliminary report].
OBJECTIVE
The molecular adsorbent recirculating system (MARSR) is a form of artificial extracorporeal liver support and can be used for a bridge to spontaneous recovery of hepatic function or liver transplantation in patients with liver failure. This study evaluated the usefulness of MARSR in patients with liver failure.


METHODS
Between January 2004 and July 2007, 30 patients (21 males and 7 females; age 48.9+/-12.9 years) with acute or acute-on-chronic liver failure were managed using MARSR. We assessed laboratory data, the grade of hepatic encephalopathy, Child-Turcotte-Pugh class, and Model for End-Stage Liver Disease (MELD) score.


RESULTS
The number of patients with acute liver failure and acute-on-chronic liver failure was 16 and 14, respectively. The mean cycle of MARSR in patients with liver failure was 2.2 sessions. After MARSR had been performed, serum total bilirubin, alanine aminotransferase (ALT), BUN, creatinine, ammonia level, daily urine output, and MELD score were improved (p<0.05). In contrast, MARSR failed to improve Child-Turcotte-Pugh score and the grade of hepatic encephalopathy. Liver transplantation was performed in 8 patients. Among them, 5 (62.5%) patients survived and 3 (37.5%) patients died. Twenty two patients underwent MARSR without liver transplantation and 4 (18.2%) of them survived.


CONCLUSIONS
In patients with liver failure, MARSR improved the laboratory data and hepatic and renal function associated clinical characteristics. However, MARSR without liver transplantation did not improve survival. MARSR may be useful as a bridge therapy to liver transplantation in patients with liver failure.
Choi
Jong Won
JW
Department of Internal Medicine, Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, and Severance Hospital, Seoul, Korea.
Yoon
Ki Tae
KT
Park
Jun Yong
JY
Kim
Ja Kyung
JK
Ahn
Sang Hoon
SH
Paik
Yong Han
YH
Lee
Kwan Sik
KS
Han
Kwang Hyub
KH
Chon
Chae Yoon
CY
Kim
Do Young
DY
D000328:Adult; D019963:Clinical Chemistry Tests; D003131:Combined Modality Therapy; D005260:Female; D006501:Hepatic Encephalopathy; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016060:Sorption Detoxification / Q000379:methods*