Liver Int. 2006 Aug;26(6):695-702.
Chiu A, Chan LM, Fan ST.
Intensive Care Unit, Queen Mary Hospital, Hong Kong, China.
BACKGROUND: The molecular adsorbent recirculating system (MARS) is an
extracorporeal liver dialysis system that allows selective removal of bilirubin
and other albumin-bound toxins. We reported here our experience with the use of
this technique for management of liver failure at Queen Mary Hospital, Hong Kong.
METHODS: From December 2002 to 2004, a total of 74 MARS sessions were performed
on 22 patients. The cause of liver failure included acute liver failure (n = 2),
acute on chronic liver failure (n = 12), posthepatectomy liver failure (n = 4),
and posttransplantation allograft failure (n = 4). RESULTS: MARS treatment showed
significant reduction in total bilirubin level, serum ammonia level and blood
urea, and nitrogen (P < 0.001 for all three parameters). Five patients (22.7%)
were able to bridge to transplantation and one patient (4.5%) made a spontaneous
recovery. The 30-day mortality rate was 72.7%. CONCLUSIONS: Our results indicated
that MARS can effectively improve serum biochemistry and is suitable for
temporarily supporting patients with liver failure where transplantation is not
immediately available. There is, however, no clear evidence showing that MARS can
increase survival, improve the chance of transplantation or assist liver
regeneration. Future studies in the form of randomized-controlled trials are
crucial to characterize the true potential of this treatment.