MARS dialysis in decompensated alcoholic liver disease: A single-center experience

Wolff, Birger; Machill, Klaus; Schumacher, Detlef; Schulzki, Ilona

doi:10.1002/lt.21235

Cited by 19 publications

(8 citation statements)

References 15 publications

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“…In addition to medical treatment directed at the underlying pathophysiologic abnormalities, several studies have tested other aggressive interventions in patients with AH, such as a molecular adsorbent recirculating system 225. Although the results of early studies were optimistic, with better than predicted outcomes in treated patients, a further case series was less promising 226. Case reports have also described the outcome of patients with severe AH treated with leukocytapharesis after failing to improve substantially on steroids 227, 228.…”

Section: Therapymentioning

confidence: 99%

Alcoholic liver disease

2009

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Section: Therapymentioning

confidence: 99%

Alcoholic liver disease

2009

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“…These devices, such as the Molecular Adsorbent Recirculating System (MARS; Gambro, Sweden) and the Prometheus (Fresenius Medical Care, Germany) platform have been shown to be effective for the reduction of plasma bilirubin, bile acids, and other albumin-bound molecules (49, 50). Although some reports point to the potential utility of these approaches as bridge treatments prior to organ transplantation (51–53), improvements in patient outcome have not been fully demonstrated (54, 55), suggesting that additional trials are required to fully evaluate their effectiveness. In particular, initial clinical studies have illustrated beneficial effects on organ function without an associated improvement in transplant-free survival (55, 56), which further underscores the complexity of liver failure events and the need for controlled clinical trials.…”

Section: Design and Development Of Existing Cell-based Therapeutic Inmentioning

confidence: 99%

Cell and tissue engineering for liver disease

et al. 2014

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Despite the tremendous hurdles presented by the complexity of the liver’s structure and function, advances in liver physiology, stem cell biology and reprogramming, and the engineering of tissues and devices are accelerating the development of cell-based therapies for treating liver disease and liver failure. This State of the Art Review discusses both the near and long-term prospects for such cell-based therapies and the unique challenges for clinical translation.

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“…This suggests that MARS treatment in these patients was not beneficial, as it did not seem to improve the final outcome. Recently, a study by Wolff et al [32] led to a similar conclusion. Considering the poor survival results in patients with alcohol-related AOCLF, one might argue that MARS treatment should have been commenced earlier in the course of the disease, to benefit the patient.…”

Section: Discussionmentioning

confidence: 65%

Survival predictors in patients treated with a molecular adsorbent recirculating system

Kantola¹,

Koivusalo²,

Parmanen³

et al. 2009

WJG

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AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system (MARS). METHODS:MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery, and as a bridge to liver transplantation (LTX). We analyzed the 1-year outcomes of 188 patients treated with MARS, from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic, clinical and laboratory parameters were recorded before and after each treatment. One-year survival and the number of LTXs were recorded. Logistic regression analysis was performed to determine factors predicting survival. RESULTS:The study included 113 patients with acute liver failure (ALF), 62 with acute-on-chronic liver failure (AOCLF), 11 with graft failure (GF), and six with miscellaneous liver failure. LTX was performed for 29% of patients with ALF, 18% with AOCLF and 55% with GF. The overall 1-year survival rate was 74% for ALF, 27% for AOCLF, and 73% for GF. The poorest survival rate, 6%, was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis, whereas, patients with enlarged and steatotic liver had 55% survival. The etiology of liver failure was the most important predictor of survival (P < 0.0001). Other prognostic factors were encephalopathy (P = 0.001) in paracetamol-related ALF, coagulation factors (P = 0.049) and encephalopathy (P = 0.064) in non-paracetamol-related toxic ALF, and alanine aminotransferase (P = 0.013) and factor V levels (P = 0.022) in ALF of unknown etiology. CONCLUSION:The etiology of liver disease was the most important prognostic factor. MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.

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MARS dialysis in decompensated alcoholic liver disease: A single-center experience

Cited by 19 publications

References 15 publications

Alcoholic liver disease

Alcoholic liver disease

Cell and tissue engineering for liver disease

Survival predictors in patients treated with a molecular adsorbent recirculating system

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