title: Meta-analysis of survival with the molecular adsorbent recirculating system for liver failure.
abstract: This study aims to assess the treatment effects of the molecular adsorbent recirculating system (MARS) in patients with acute and acute-on-chronic liver failure. We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Registry database between January 1966 and January 2014. We included randomized controlled trials, which compared the treatment effects of MARS with standard medical treatment. Study quality assessed according to Consolidated Standards of Reporting Trials (CONSORT) criteria. The risk ratio was used as the effect-size measure according to a fixed-effects model. The search strategy revealed 72 clinical studies, 10 of which were randomized controlled trials that met the criteria and were included. Four addressed ALF (93 patients) and six addressed AOCLF (453 patients). The mean CONSORT score was 15 (range 10-20). By meta-analysis, MARS significantly improved survival in ALF (risk ratio 0.61; 95% CI 0.38, 0.97; P = 0.04). There was no significant survival benefit in AOCLF (risk ratio 0.88; 95% CI 0.74, 1.06; P = 0.16). MARS significantly improved survival in patients with acute liver failure, however, there is no evidence that it improved survival in patients with acute-on-chronic liver failure. In conclusion, the present meta-analysis indicates that MARS therapy can improve survival in patients with ALF. It is necessary to develop MARS treatment because of the increasing demand for liver transplantation and the risk of liver failure.
authors.affiliation: Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University Number 253 Industry Road, Hai Zhu District, Guangdong Province, Guangzhou 510280, China.
authors.forename: Guo-Lin
authors.initials: GL
authors.lastname: He
authors.affiliation: Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University Number 253 Industry Road, Hai Zhu District, Guangdong Province, Guangzhou 510280, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.affiliation: Department of Biostatistics, Southern Medical University Guangzhou 510280, Guangdong Province, China.
authors.forename: Chong-Yang
authors.initials: CY
authors.lastname: Duan
authors.affiliation: Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University Number 253 Industry Road, Hai Zhu District, Guangdong Province, Guangzhou 510280, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Hu
authors.affiliation: Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University Number 253 Industry Road, Hai Zhu District, Guangdong Province, Guangzhou 510280, China.
authors.forename: Chen-Jie
authors.initials: CJ
authors.lastname: Zhou
authors.affiliation: Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University Number 253 Industry Road, Hai Zhu District, Guangdong Province, Guangzhou 510280, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University Number 253 Industry Road, Hai Zhu District, Guangdong Province, Guangzhou 510280, China.
authors.forename: Ming-Xin
authors.initials: MX
authors.lastname: Pan
authors.affiliation: Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University Number 253 Industry Road, Hai Zhu District, Guangdong Province, Guangzhou 510280, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Gao
keywords: Hepatic failure; liver failure; liver-assisted device; meta-analysis; molecular adsorbent recirculating system