Molecular adsorbents recirculating system in patients with severe liver failure. Experience of a single Romanian centre.
OBJECTIVE
This is a retrospective, observational study regarding the experience of the Fundeni Clinical Institute in the application of the Molecular Adsorbents Recirculating System in patients with liver failure.


METHODS
From January 2002 until December 2007, we performed 50 MARS sessions in 27 patients, mean age 38.96+/-19.58 years. The etiology of liver failure was as follows: acute liver failure (ALF) in 7 patients, acute-on-chronic liver failure (AoCLF) in 10 patients, post-liver transplantation in 8 patients, and post-hepatectomy in 2 patients.


RESULTS
We noticed the following clinical effects: improvement in general condition, in neurological status, marked regression of jaundice and pruritus, improvement in renal function and in hemodynamic status. Of the 7 patients with ALF, 3 patients (42.8 %) survived due to their own liver recovery. Only 2 patients (20%) with AoCLF survived. In this group, one patient was transplanted, one patient is alive, and the mean survival of the remaining patients was 24.5+/-34.6 days. In the post-liver transplantation group, one patient was retransplanted, one patient is alive and the mean survival of the other 6 patients was 28.5+/-39.8 days. One patient with post-hepatectomy liver failure presented spontaneous liver recovery.


CONCLUSIONS
MARS therapy was well tolerated by the patients. MARS therapy efficiently removed water soluble and albumin-bound toxins. The unfavorable prognostic factors were the association with multi organ failure and sepsis.
Center of Internal Medicine and Nephrology, Fundeni Clinical Institute, 258 Fundeni Street, sector 2 Bucharest, Romania.
Elena-Emanuela
EE
Rusu
Mihai
M
Voiculescu
Diana-Silvia
DS
Zilisteanu
Gener
G
Ismail
D000328:Adult; D006498:Hepatectomy; D006801:Humans; D017093:Liver Failure / Q000628:therapy*; D017114:Liver Failure, Acute / Q000628:therapy; D016031:Liver Transplantation; D019164:Liver, Artificial; D008875:Middle Aged; D012189:Retrospective Studies