Role of the molecular adsorbent recycling system (MARS) in the treatment of patients with acute exacerbation of chronic liver failure

Sorkine, Patrick; Abraham, Ron Ben; Szold, Oded; Biderman, Philippe; Kidron, A; Merchav, Hadar; Brill, Shai; Oren, Ran

doi:10.1097/00003246-200107000-00006

Cited by 146 publications

(109 citation statements)

References 17 publications

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“…This effects the removal of such albuminbound toxins as aromatic amino acids, bilirubin, bile acids, phenols, short-and middle-chain fatty acids, and copper, together with such free solutes as ammonia, creatinine, and urea that are removed by standard dialysis. 1,2,5,6 MARS has shown specific efficacy in the treatment of acute-on-chronic hepatic failure, [7][8][9][10][11] in which it improves cerebral blood flow; hemodynamic, liver, and renal function; coagulation; and survival. [7][8][9][10][11][12][13] Although pruritus has been described as a possible presenting symptom for hepatitis C virus (HCV)-and/or chronic hepatitis-related cirrhosis, it is considered a rare finding in this setting.…”

Section: A Molecular Adsorbent Recirculating System (Mars)mentioning

confidence: 99%

Effect of molecular adsorbent recirculating system in hepatitis C virus-related intractable pruritus

Doria

Mandalà

Smith

et al. 2003

Liver Transplantation

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Section: A Molecular Adsorbent Recirculating System (Mars)mentioning

confidence: 99%

Effect of molecular adsorbent recirculating system in hepatitis C virus-related intractable pruritus

Doria

Mandalà

Smith

et al. 2003

Liver Transplantation

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“…5,6 Albumin dialysis devices, such as the molecular adsorbents recirculating system (MARS), have safely and efficiently removed albumin-bound, as well as water-soluble, substances without adverse effects on hemodynamics in patients with acute-on-chronic liver failure. [7][8][9] Assuming that systemic vasodilatation in patients with HALF is caused by circulating toxins removable by MARS, blood pressure and SVRI would be expected to increase during MARS treatment. 2,3 However, MARS is performed using a conventional dialysis machine at flow rates similar to those used for intermittent hemodialysis.…”

mentioning

confidence: 99%

Systemic hemodynamic effects of treatment with the molecular adsorbents recirculating system in patients with hyperacute liver failure: A prospective controlled trial

Schmidt

Wang

Hansen

et al. 2003

Liver Transplantation

208

106

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The aim of the study is to evaluate the effect of a single treatment with the molecular adsorbents recirculating system (MARS) on systemic hemodynamics and oxygen consumption (VO 2 ) in patients with hyperacute liver failure (HALF). In a controlled design, eight patients with HALF were assigned to a 6-hour MARS treatment, and five patients, to a control group that was mechanically cooled to match the MARS group. Systemic hemodynamic variables were determined hourly during the study period. In the MARS group, systemic vascular resistance index increased by 46% from 1,215 ؎ 437 to 1,778 ؎ 710 dynes ⅐ s ⅐ cm ؊5 ⅐ m ؊2 (P < .0001), which significantly exceeded a 6% increase in the control group. Mean arterial pressure increased from 69 ؎ 5 to 83 ؎ 11 mm Hg in the MARS group (P < .0001) and was unchanged in the control group. Cardiac index decreased by 20% from 4.6 ؎ 1.8 to 3.7 ؎ 1.1 L/min ⅐ m ؊2 (P ‫؍‬ .0007) in the MARS group and by 7% in the control group. Heart rate decreased from 105 ؎ 21 to 85 ؎ 15 beats/min in the MARS group (P < .0001) and was unchanged in the control group. In the MARS group, oxygen delivery decreased from 621 ؎ 198 to 486 ؎ 141 mL/min ⅐ m ؊2 (P < .05), and VO2, from 142 ؎ 31 to 112 ؎21 mL/min ⅐ m ؊2 (P < .05). Arterial lactate and pH levels were unchanged. In conclusion, systemic hemodynamic values tend to normalize, whereas systemic VO 2 decreases during MARS treatment in patients with HALF. These effects cannot be explained by the degree of cooling associated with MARS. (Liver Transpl 2003;9: 290-297.)

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“…Initial studies with MARS, although small and uncontrolled, were performed in the setting of AoCLF. [27][28][29][30][31][32] The largest of these studies, 30 a prospective case series of 26 patients with AoCLF and intrahepatic cholestasis (bilirubin >20 mg/dL), resulted in an in-hospital survival of 44% (seven of 16) for patients with UNOS-2a while all UNOS-2b status patients (10 of 10) survived. Clinical effectiveness was associated with improvement of hyperbilirubinaemia, hepatic encephalopathy, circulatory and renal dysfunction and Child-Pugh score.…”

Section: Clinical Indications and Efficacymentioning

confidence: 99%

Review article: non‐biological liver support in liver failure

Laleman¹,

Wilmer²,

Evenepoel³

et al. 2006

Aliment Pharmacol Ther

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SUMMARYLiver failure, whether acute or acute-on-chronic, remains an important cause of morbidity and mortality. The lack of liver detoxification, metabolic and regulatory functions of the liver leads to life-threatening complications, such as renal failure, altered immune response, hepatic coma and systemic haemodynamic dysfunction, eventually culminating in multiorgan failure.Current medical therapy involves the management of the precipitating event and treatment of complications until the liver eventually recovers, leaving us with no other treatment options than transplantation if these attempts fail. However, the shortage in cadaveric organs and other transplant-related problems, have prompted the need for alternative methods to provide liver support.As liver failure is often potentially reversible, considerable effort has been invested in the development of liver support systems. Currently, most of the experience is available for non-biological support systems. They represent the focus of this review, which aims to define the goals of liver support, to describe the design of the different existing devices and to analyse the available data to determine their current status in the management of patients with liver failure.

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Role of the molecular adsorbent recycling system (MARS) in the treatment of patients with acute exacerbation of chronic liver failure

Cited by 146 publications

References 17 publications

Effect of molecular adsorbent recirculating system in hepatitis C virus-related intractable pruritus

Effect of molecular adsorbent recirculating system in hepatitis C virus-related intractable pruritus

Systemic hemodynamic effects of treatment with the molecular adsorbents recirculating system in patients with hyperacute liver failure: A prospective controlled trial

Review article: non‐biological liver support in liver failure

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