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An Australian experience with the molecular adsorbents recirculating system (Mars)
Jelica Kurtovic1, Martin Boyle, David Bihari
1Gastrointestinal and Liver Unit, The Prince of Wales Hospital, Sydney, New South Wales, Australia.
Summary
Molecular adsorbent recirculating system (MARS) therapy shows potential for removing toxins in severe liver failure. However, survival rates remain poor, indicating a need for further research on optimal patient selection and timing.
Area of Science:
- Hepatology
- Critical Care Medicine
- Artificial Organ Technology
Background:
- Severe liver damage can lead to multi-organ failure.
- Albumin-bound toxins are implicated in liver disease pathogenesis.
- Acute liver failure and acute-on-chronic liver failure (AoCLF) present significant clinical challenges.
Purpose of the Study:
- To assess the efficacy of Molecular Adsorbent Recirculating System (MARS) therapy.
- To evaluate MARS in patients with severe liver damage unresponsive to intensive medical therapy.
- To explore MARS utility in late-stage liver failure, including AoCLF with sepsis.
Main Methods:
- MARS therapy was administered to six patients with severe liver dysfunction.
- Outcome measures included hemodynamic stability, renal function, and biochemical markers.
- Evaluated hepatic encephalopathy, arterial ammonia, and indocyanine green clearance.
Main Results:
- MARS treatment showed potential clinical efficacy in advanced multi-organ dysfunction.
- Markers of liver function and stability showed some improvement.
- Overall survival rate was low (17%), with only one patient surviving.
Conclusions:
- MARS therapy may offer some benefit in severe liver damage, even when initiated late.
- The poor survival rate highlights the critical condition of the studied patients.
- Further randomized controlled trials are essential to define patient subgroups and optimal timing for MARS intervention.
