Use of MARS in the Treatment of Acute Liver Failure: Preliminary Monocentric Experience

Abstract

SUPPLEMENT nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn n As reported in the literature, the mortality rate for patients with Acute Hepatic Failure (AHF) approaches 80 % in cases in which liver transplantation is not possible.Post transplant mortality depends on the seriousness of the neurological condition at the time of the operation (20 % in I-II degree coma patients and 44 % in III degree coma patients). This is the rationale for extracorporeal depuration treatment, as a bridge to transplantation, both in AHF and in Primary Non Function (PNF) cases.The recirculating molecular adsorption system (MARS), whose only function is to depurate through a "hybrid" membrane removing toxic substances related to albumin, has advantage in that it can be used for long periods. The aim of this study is to report on our experience in the use of MARS on 10 AHF patients (4 PNF, 2 delayed non function, 4 fulminant hepatitis). The average age was 41,8 years (range 23-56), 6 were male, 4 female. All had bilirubin 8805; 15 mg/ dl and ammonia 8805; 160 g/dl. MARS was applied for 8 € 1,5 hours a day. The average number of treatments was 6,4 (range 1-24).The EEG, hepatic and renal parameters were monitored before and after the treatment, while the hemodynamic parameters were monitored during the treatment.No hemodynamic complications occured during the treatment. A significant reduction in bilirubin (p < 0,01) and ammonia (p < 0,01) was observed. the average INR level at the onset of treatment was 2,05, at the end 1,59. After the treatment there was an improvement in neurological conditions. Three of the PNF patients recovered function of the transplanted organ and survived without further transplantations. The same applies for the two patients with delayed non function. All fulminant hepatitis patients were successfully bridged to transplantation, three subsquently died from complications, one was discharged in good condition.On the basis of our preliminary studies, the MARS treatment was found to be safe with a high tolerance rate, having a role in AHF treatment as bridge to liver transplantation or waiting for the graft to recover its functionality.

Successful MARS Treatment in Severe Cholestatic Patients with Acute on Chronic Liver Failure

“…A difficulty that arises when examining the clinical reports presented in the literature on MARS is the inability of this device to support patients up to a spontaneous recovery, with the exception of few cases (17,18). In our series, all patients who were not transplanted died because a life‐threatening infective complication occurred.…”

Artificial and bioartificial liver devices: present and future

“…The highest incidence of liver recovery was observed in patients with ALF due to intoxication 3. Some authors have reported the successful support of patients with ALF before liver transplantation 44. The impact of MARS on the outcome of patients with A-on-C LF is controversial.…”

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

“…MARS treatment has already been used successfully in patients with EAD in other centers, but to date, the data are limited. Novelli et al 27 reported on six patients, five of whom recovered while receiving MARS treatment. Results of another eight patients, of whom three recovered and four were successfully bridged to OLT, have been reported by Stange et al 14 In the present study, we prospectively enrolled and treated 12 patients who met our inclusion criteria for EAD.…”