Korean J Gastroenterol.  2009 Jul;54(1):28-35. 10.4166/kjg.2009.54.1.28.

Usefulness and Safety of Extracorporeal Liver Support Therapy Using MARS(R) for Patients with Liver Failure: A Preliminary Report

• Choi JW
• Yoon KT
• Park JY
• Kim JK
• Ahn SH
• Paik YH
• Lee KS
• Han KH
• Chon CY
• Kim DY

• KMID: 1792763
• DOI: http://doi.org/10.4166/kjg.2009.54.1.28

Abstract

BACKGROUND/AIMS
The molecular adsorbent recirculating system (MARS(R)) 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 MARS(R) 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 MARS(R). 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 MARS(R) in patients with liver failure was 2.2 sessions. After MARS(R) 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, MARS(R) 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 MARS(R) without liver transplantation and 4 (18.2%) of them survived. CONCLUSIONS: In patients with liver failure, MARS(R) improved the laboratory data and hepatic and renal function associated clinical characteristics. However, MARS(R) without liver transplantation did not improve survival. MARS(R) may be useful as a bridge therapy to liver transplantation in patients with liver failure.

Keyword

Liver failure; Molecular adsorbent recirculating system (MARS(R)); Liver transplantation

MeSH Terms

Adult
Clinical Chemistry Tests
Combined Modality Therapy
Female
Hepatic Encephalopathy
Humans
Liver Failure/mortality/surgery/*therapy
Liver Transplantation
Male
Middle Aged
Retrospective Studies
Severity of Illness Index
Sorption Detoxification/*methods

Figure

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  Fig. 1. MARSⓇ in patients with acute liver failure. ALF, acute liver failure; LT, liver transplantation.

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  Fig. 2. MARSⓇ in patients with acute-on-chronic liver failure. AoCLF, acute-on-chronic liver failure; LT, liver transplantation.

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