Molecular adsorbent recirculating system in patients with early allograft dysfunction after liver transplantation: A pilot study

Abstract

Early allograft dysfunction (EAD) after orthotopic liver transplantation (OLT) causes marked morbidity and mortality. We conducted a prospective pilot study to assess the safety and efficacy of molecular adsorbent recirculating system (MARS) in treatment of EAD after OLT. Twelve consecutive adult liver allograft recipients with a median age of 48 years, 9 of whom were male, were prospectively included and supported with MARS. EAD was defined as the presence of at least 2 of the following: serum bilirubin Ͼ10 mg/dL, prothrombin time Ͻ40%, aspartate aminotransferase or alanine transferase Ͼ1,000 U/L, and plasma disappearance rate of indocyanine green (PDR ICG ) Ͻ10% per minute within 72 hours after reperfusion. One-year patient and graft survival was 66%. There was a significant decrease in serum bilirubin (P ϭ 0.002), serum creatinine (P ϭ 0.006), and aspartate aminotransferase (P ϭ 0.005) and a significant increase in PDR ICG (P ϭ 0.007) after MARS treatment. Prothrombin time, albumin level, and platelet count remained stable. Sustained improvement of renal and neurological function and of mean arterial pressure were observed. No MARS-related adverse effects occurred. MARS treatment provides a safe approach to the treatment of EAD after OLT. On the basis of this pilot study, a multicenter randomized clinical trial that uses MARS treatment in EAD after OLT has been initiated.

Acute-on-chronic liver failure: extracorporeal liver assist devices

“…Multiple studies have demonstrated the efficacy of albumin dialysis in decreasing total bile acid pool and bilirubin concentration, providing relief of the clinical manifestations of cholestasis [43,44]. MARS treatment could be a useful tool in facilitating hepatic recovery in patients with severe drug-induced liver injury with features of cholestasis, posttransplant cholestasis due to graft dysfunction, and in liver failure patients awaiting transplantation [45,46,47 ]. Albumin dialysis is also effective in improving intractable pruritis from severe cholestasis in some patients with cholestatic conditions [48,49 ].…”

Hypoxic hepatitis – epidemiology, pathophysiology and clinical management

“…Studies have suggested that MARS therapy improved the hemodynamic situation in patients with acute and acute-on-chronic liver failure [95]. Several groups observed an increase in arterial pressure, systemic vascular resistance index, a decrease in portal pressure and improvement of renal blood fl ow [95][96][97][98][99][100]. MARS may therefore be a therapeutic option of potential interest in patients with HH.…”

Indocyanine green enhanced near‐infrared laser treatment of murine mammary carcinoma

“…Thus, it is mostly confined to the intravascular space, with minimal leakage, even from abnormal or fenestrated vessels 3. Under physiological conditions, ICG is exclusively eliminated from the blood through the liver and excreted chemically unchanged into the bile 3–6…”