title: The molecular adsorbent recirculating system as a liver support system: summary of Mexican experience.
abstract: OBJECTIVE
  The aim of this study was to assess the effects of the molecular absorbent recirculating system (MARS) on patients with acute liver failure (ALF) and liver failure with cirrhosis (AoCLF) as well as in cholestatic patients with intractable pruritus in a Mexican population.
  
  
  METHODS
  From August 2003 to December 2011, MARS was used in 38 patients with ALF, 15 patients with AoCLF, and 17 cholestatic patients with intractable pruritus. The patients were examined using a standard liver function test and for vital signs, presence of ascites and encephalopathy before and after each treatment. The therapeutic response, patient status, follow-up status, and need for liver transplantation were determined.
  
  
  RESULTS
  Seventy-nine MARS procedures were performed. MARS was used for ALF in 54.3% of patients, AoCLF in 24.2%, and cholestatic disease in 21.5%. There were significant improvements in serum bilirubin (p = 0.000), aspartate aminotransferase (p = 0.000), alanine aminotransferase (p = 0.030), gamma-glytamyl transpeptidase (p = 0.044), alkaline phosphatase (p = 0.006), and encephalopathy grade (p = 0.000). Thirty-eight ALF patients were listed for emergency liver transplantation and treated with MARS; 20 of these patients died on a waiting list, 18 survived. only four underwent liver transplantation and 14 (37%) recovered without transplantation after the MARS procedure.
  
  
  CONCLUSIONS
  MARS is a safe and effective procedure, especially for ALF patients. Our results suggest that MARS therapy can contribute to native liver recovery in ALF patients.
authors.affiliation: Hospital San José Tec de Monterrey. Ciudad de México, México.
authors.forename: Laura Esthela
authors.initials: LE
authors.lastname: Cisneros-Garza
authors.affiliation: Unidad Médica de Alta Especialidad # 25 Instituto Mexicano del Seguro Social, Monterrey.Ciudad de México, México.
authors.forename: Ma del Rosario
authors.initials: Mdel R
authors.lastname: Muñoz-Ramírez
authors.affiliation: Unidad Médica de Alta Especialidad # 25 Instituto Mexicano del Seguro Social, Monterrey.Ciudad de México, México.
authors.forename: Linda Elsa
authors.initials: LE
authors.lastname: Muñoz-Espinoza
authors.affiliation: Hospital Universitario de Monterrey.Ciudad de México, México.
authors.forename: José Antonio Velarde
authors.initials: JA
authors.lastname: Ruiz Velasco
authors.affiliation: Hospital Civil de Guadalajara. Ciudad de México, México.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Moreno-Alcántar
authors.affiliation: Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social, México.Ciudad de México, México.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Marín-López
authors.affiliation: Hospital de la Beneficiencia Española. Puebla. Unidad de Hígado. Fundación Clínica Médica Sur. Ciudad de México, México.
authors.forename: Nahum
authors.initials: N
authors.lastname: Méndez-Sánchez
mesh_terms: D000328:Adult; D002779:Cholestasis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008021:Life Support Systems / Q000295:instrumentation*; D008099:Liver / Q000201:enzymology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D017114:Liver Failure, Acute / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014850:Waiting Lists