title: Molecular adsorbent recirculating system (MARS) in acute liver injury and graft dysfunction: Results from a case-control study.
abstract: BACKGROUND
  The primary therapeutic goals in the treatment of liver injury are to support liver regeneration or bridge the gap to liver transplantation (LT). Molecular adsorbent recirculating system (MARS) therapy has shown beneficial effects for specific symptoms of liver failure; however, general survival advantages have not yet been demonstrated.
  
  
  OBJECTIVE
  We studied the effects of MARS therapy compared to standard medical treatment (SMT) in two patient cohorts: in patients with an acute liver injury and in those with graft dysfunction (GD).
  
  
  METHODS
  We report on our experience over a 6.5-year period with 73 patients treated with SMT or with SMT and MARS (MARS group). In total, 53 patients suffered from acute liver injury in their native liver without a preexisting liver disease (SMT: n = 31, MARS: n = 22), and 20 patients showed a severe GD after LT (SMT: n = 10, MARS: n = 10).
  
  
  RESULTS
  The entire cohort was predominantly characterized by hemodynamically and respiratorily stable patients with a low hepatic encephalopathy (HE) grade and a model of end-stage liver disease (MELD) score of 20.57 (MARS) or 22.51 (SMT, p = 0.555). Within the MARS group, the median number of extracorporeal therapy sessions was four (range = 3-5 sessions). Independent of the underlying etiology, MARS improved the patients' bilirubin values in the short term compared to SMT alone. In patients with acute liver injury, this response was sustained even after the end of MARS therapy. By contrast, the majority of patients with GD and an initial response to MARS therapy experienced worsened hyperbilirubinemia. No differences in 28-day mortality were observed with respect to acute liver injury (MARS 5.3% (95% CI: 0-15.3); SMT 3.3% (95% CI: 0-9.8), p = 0.754) or GD (MARS 20.0% (95% CI: 0-44.7), SMT 11.1% (95% CI: 0-31.7), p = 0.478).
  
  
  CONCLUSIONS
  Although it did not improve 28-day mortality, MARS therapy improved the short-term response in patients with acute liver injury as well as in those with GD. In cases of acute hepatic injury, the use of MARS therapy resulted in the sustained stabilization of liver function and improved liver regeneration. A short-term response to MARS may predict the future course of the disease.
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Muenster, Muenster, Germany.
authors.forename: Hans U
authors.initials: HU
authors.lastname: Gerth
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital Muenster, Muenster, Germany.
authors.forename: Michele
authors.identifier: http://orcid.org/0000-0002-0333-0297
authors.initials: M
authors.lastname: Pohlen
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Muenster, Muenster, Germany.
authors.forename: Gerold
authors.initials: G
authors.lastname: Thölking
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Muenster, Muenster, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Pavenstädt
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Muenster, Muenster, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Brand
authors.affiliation: Department of Transplant Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wilms
authors.affiliation: Department of Transplant Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Hüsing-Kabar
authors.affiliation: Institute of Biostatistics and Clinical Research, University Muenster, Muenster, Germany.
authors.forename: Dennis
authors.initials: D
authors.lastname: Görlich
authors.affiliation: Department of Transplant Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Iyad
authors.initials: I
authors.lastname: Kabar
authors.affiliation: Department of Transplant Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Hartmut H J
authors.initials: HH
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D016022:Case-Control Studies; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000628:therapy*; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000628:therapy*; D006801:Humans; D008099:Liver / Q000473:pathology; D008115:Liver Regeneration; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016060:Sorption Detoxification; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin