Adverse events, short- and long-term outcomes of extra corporeal liver therapy in the intensive care unit: 16 years experience with MARS® in a single center

Abstract

Background Molecular Adsorbent Recirculating System (MARS®) is a non-biological artificial liver device. The benefit risk ratio between uncertain clinical effects and potential adverse events remains difficult to assess. We sought to describe adverse events related to MARS® therapy as well as biological and clinical effects. Methods All intensive care unit (ICU) admissions to whom MARS® therapy was prescribed from March 2005 to August 2021 were consecutively and prospectively included. The main endpoint was the incidence of adverse events related to MARS® therapy. Secondary endpoints were the biological and clinical effects of MARS® therapy. Results We reported 180 admissions treated with MARS® therapy. Among the 180 admissions, 56 (31.1%) were for acute-on-chronic liver failure, 32 (17.8%) for acute liver failure, 28 (15.5%) for post-surgery liver failure, 52 (28.9%) for pruritus and 12 (6.7%) for drug intoxication. At least one adverse event occurred in 95 (52.8%) admissions. Thrombocytopenia was the most frequent adverse event which was recorded in 55 admissions (30.6%). Overall, platelets count was 131 (± 95) × 109/L before and 106 (± 72) × 109/L after MARS® therapy (p < .001). After MARS® therapy, total bilirubin was significantly decreased in all groups (p < 0.05). Hepatic encephalopathy significantly improved in both the acute-on-chronic and in the acute liver failure group (p = 0.01). In the pruritus group, pruritus intensity score was significantly decreased after MARS® therapy (p < 0.01). Conclusion In this large cohort of patients treated with MARS® therapy we report frequent adverse events. Thrombocytopenia was the most frequent adverse event. In all applications significant clinical and biological improvements were shown with MARS® therapy.

Blood Purification in Hepatic Dysfunction after Liver Transplant or Extensive Hepatectomy: Far from the Best-Case Scenarios

“…In our patients, the decrease in platelet count was clinically substantial and required multiple transfusions, with a potential negative impact exerted on clinical outcomes, including an increased occurrence of severe complications and higher mortality [21][22][23][24][25][26][27]. Thrombocytopenia was also the most frequent adverse event in a large cohort of patients treated with MARS ® therapy [28]. However, in our case series, the thrombocytopenia was possibly not due to the treatment of CytoSorb ® alone, but to its combination with renal replacement therapy [29][30][31][32][33].…”

Case Report: Efficacy of albumin dialysis for the reversal of bile cast nephropathy-induced acute kidney injury

“…The molecular adsorbent recirculating system (MARS) is an extracorporeal liver support system that has shown promise in the treatment of various liver diseases, including acute liver failure (ALF), acute-on-chronic liver failure as a bridge to transplant, and intractable pruritus ( 8 – 10 ). MARS functions by removing albumin-bound toxins, including bilirubin and bile acids, from the patient’s blood through a combination of continuous renal replacement therapy (CRRT) and the addition of adsorption therapy via the MARS circuit ( 11 , 12 ) ( Figure 1 ). With regard to BCN-associated AKI, the strategy of using MARS aims to reduce the burden of cholestasis to mitigate the toxic effects of bilirubin on the renal tubules and potentially promote renal recovery.…”