Molecular Absorbent Recirculating System for the Treatment of Acute Liver Failure in Surgical Patients

Abstract

The Molecular Adsorbent Recirculating System (MARS) represents an attractive artificial liver support system for the treatment of liver insufficiency. However, neither indications for MARS treatment (i.e., after extended liver resection) nor criteria for discontinuation of therapy have been evaluated. Therefore, we analyzed the clinical data of all our surgical patients who received MARS treatment for acute liver failure (n = 7). The aim of the study was to identify prognostic indicators for survival. Four of 174 patients resected for hepatic malignancy at our institution received a total of 13 MARS treatments. Two additional patients were successfully bridged to orthotopic liver transplantation with seven MARS treatments and one patient was MARS supported after liver transplantation of a steatotic graft with three MARS treatments. Five of the seven patients survived and were dismissed an average of 31 days, ranging from 17 to 47 days, after the final MARS treatment. No technical complications or adverse effects were observed during the MARS treatments. Important prognostic factors for hepatic recovery and survival were indocyanin green plasma disappearance rates greater than 5%/min and an increase in clotting factor V levels after each MARS treatment. We conclude that MARS therapy can be an effective treatment of postoperative liver insufficiency in the surgical hepatobiliary unit.

Validation of the Estimation of Physiologic Ability and Surgical Stress (E‐PASS) Score in Liver Surgery

“…Other studies looked at a combination of the ChildPugh score with the indocyanine green retention test and CT volumetry to best predict the short-and long-term outcome after extended LR [20][21][22]. Although recent findings possibly contradict the long-held belief that postoperative liver failure is the main cause of mortality after major LR, an assessment of preoperative liver function remains the gold standard for patients requiring extensive surgery or for those with varying degrees of cirrhotic liver parenchyma [23].…”

Penetrating Liver Injuries

“…The system functions on dialysis, filtration, and absorption. Blood is exposed to a biocompatible high flux albumin dialysis filter with removal of both water soluble and albumin-bound toxins [33,34]. Twenty percent albumin dialysate is run counter current to the blood to transfer albumin-bound toxins to the dialysate in a system very similar to continuous renal replacement therapy [35].…”

“…Twenty percent albumin dialysate is run counter current to the blood to transfer albumin-bound toxins to the dialysate in a system very similar to continuous renal replacement therapy [35]. The exogenous albumin dialysate is then Bregenerated^by dialysis against a conventional dialysate bath and subsequent absorption from charcoal and exhange resin colums [33]. The regenerated albumin dialysate is then re-circulated to repeat the process.…”

The molecular adsorbent recirculating system in posthepatectomy liver failure: Results from a prospective phase I study

“…Large, randomized, controlled trials did, however, fail to demonstrate a statistically significant survival benefit 14, 15. In the PHLF situation, only a few single‐center experiences have addressed the use of MARS as a rescue treatment option,16, 17, 18, 19, 20 and all of them suffer from heterogeneous patient groups and a lack of standardized treatment protocols. Recently, we reported our retrospective experience with MARS for PHLF at two tertiary referral centers where we found a trend toward improved 90‐day and long‐term survival in patients who received several MARS treatments early in the postoperative course 21.…”