The effect of the molecular adsorbent recycling system (mars) on cerebral perfusion in patients with acute on chronic liver failure and hepatic encephalopathy

Schmidt, Lars E.; Svendsen, Lars Bo; Sørensen, Vibeke Rømming; Mitzner, S.; Hansen, BA; Larsen, F.S.

doi:10.1055/s-2001-919034

Cited by 2 publications

(3 citation statements)

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“…The improvement of synthetic liver function (increase in antithrombin III and Factor VII levels and prothrombin activity and increase in cholinesterase levels), together with the decrease in encephalopathy grades and ascites, may explain the decrease in Child-Turcotte-Pugh scores observed in some patients [32]. Similar results were reported in other series [33][34][35][36], in particular in 7 patients with severe cholestatic decompensation (total bilirubin > 25 mg/dl), who showed an improvement of neurological status, a hemodynamic stability, a better clinical outcome, and a survival advantage [37]. A study on 8 patients with AOCLF achieved an improvement of cerebral circulation, a decrease in brain edema and an elevation of systemic vascular resistance and mean arterial pressure [38].…”

Section: Results From Clinical Trialssupporting

confidence: 69%

“…A significant decrease in bilirubin and creatinine levels, together with a prolonged survival rate, was observed in the MARS group [30]. Moreover, in a series of 5 patients receiving a single MARS treatment an improvement of systemic vascular resistance and arterial pressure with a decrease in plasma renin activity was demonstrated [40].…”

Section: Results From Clinical Trialsmentioning

confidence: 85%

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Advances in Extracorporeal Detoxification by MARS Dialysis in Patients with Liver Failure

Campli

Verme

Andrisani

et al. 2003

CMC

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Although liver transplantation has become standard procedure for patients with liver failure, a number of issues in the management of these patients remains to be addressed. Alternative approaches have been tested, such as hepatocytes containing liver-support systems and filtration devices. However, the replacement of detoxification has been difficult, as the majority of toxins accumulating in liver failure is albumin-bound. Albumin dialysis (MARS system) is characterized by the specific removal of albumin-bound toxins through an innovative membrane transport. In particular, the albumin acts as a specific molecular adsorbent that is regenerated on line in a recycling system. Nowadays MARS represents the most frequently used liver support system. This treatment has been shown to remove albumin-bound molecules, such as bilirubin, bile acids, aromatic amino acids and copper. The removal of these toxins is clinically accompanied with an improvement of liver, cardiovascular and renal functions and hepatic encephalopathy. In several trials MARS was found to improve the clinical situation in patients with acute exacerbation of chronic liver failure and acute hepatic failure, but also in hepatorenal syndrome and primary graft non function or chronic rejection after liver transplantation. In summary, a critical analysis of the literature confirms that MARS device can be a safe therapeutic choice to achieve a better clinical outcome, and, sometimes, a survival advantage in patients with liver failure, even if a multi-center randomized trial is the only reliable way to enforce today's results. Further advances in the MARS components will definitively state whether albumin dialysis may represent the future in the field of artificial liver devices.

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Section: Results From Clinical Trialssupporting

confidence: 69%

Section: Results From Clinical Trialsmentioning

confidence: 85%

Advances in Extracorporeal Detoxification by MARS Dialysis in Patients with Liver Failure

Campli

Verme

Andrisani

et al. 2003

CMC

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“…MARS involves an actual dialysis circuit containing albumin which allows the system to function as hemofiltration. This property is effective in clearing serum ammonia (24,30), creatinine (24), and urea (24) at certain flow rates.…”

Section: Results From Laboratory Investigationsmentioning

confidence: 99%

The Molecular Adsorbents Recycling System as a Liver Support System Based on Albumin Dialysis: A Summary of Preclinical Investigations, Prospective, Randomized, Controlled Clinical Trial, and Clinical Experience from 19 Centers

Stange¹,

Hassanein²,

et al. 2002

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Artificial liver support aims to prolong survival time of patients with liver failure by detoxification. Albumin as a molecular adsorbent in dialysis solution is capable of attracting even tightly albumin-bound toxins from blood into the dialysate if a specific dialysis membrane is used and if the albumin's binding sites are on-line-purified by a sorbent/dialysis-based recycling system (i.e., molecular adsorbents recycling system, or MARS). The MARS technology has been shown to remove water-soluble and albumin-bound toxins and to provide renal support in case of renal failure. Fourteen centers have reported that MARS treatment improved mental status of patients with liver failure and hepatic encephalopathy. In treating liver failure and cholestasis, MARS was associated with hemodynamic stabilization, improvement of hepatic and kidney function, and disappearance of pruritus. In hepatic failure and hepatorenal syndrome, a prospective, randomized, controlled trial of MARS treatment was able to prolong survival time significantly. MARS has been used in 26 patients with acute liver failure or primary graft dysfunction. Nineteen centers reporting on 103 patients have shown that MARS treatment is safe, easy to handle, feasible, and effective.

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The effect of the molecular adsorbent recycling system (mars) on cerebral perfusion in patients with acute on chronic liver failure and hepatic encephalopathy

Cited by 2 publications

References 0 publications

Advances in Extracorporeal Detoxification by MARS Dialysis in Patients with Liver Failure

Advances in Extracorporeal Detoxification by MARS Dialysis in Patients with Liver Failure

The Molecular Adsorbents Recycling System as a Liver Support System Based on Albumin Dialysis: A Summary of Preclinical Investigations, Prospective, Randomized, Controlled Clinical Trial, and Clinical Experience from 19 Centers

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