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Continuous molecular adsorbent recirculating system treatment in 69 patients listed for liver transplantation
Per Olin1, John Hausken, Aksel Foss
1Department of Emergencies and Critical Care, Oslo University Hospital , Oslo , Norway.
Objective:
The molecular adsorbent recirculating system (MARS) is used to purify blood from albumin-bound toxins in patients with liver failure. However, the application of MARS has not demonstrated improved survival in randomized clinical trials and the clinical utility has not been finally established. In our department, the use of MARS is now restricted to the most critically ill patients with acute or acute on chronic liver failure.
Material And Methods:
Since 2005, we have treated 69 patients (30 males/39 females with median age of 49 years ranging from 1 months to 70 years) listed for liver transplantation (LT) with MARS. Median model of end-stage liver disease score in patients older than 12 years of age (n = 56) was 33 (interquartile range 26-39). The flow rate was 35-40 mL/kg/h and treatment kits were changed every 8-12 h. The patients were treated for a median of 27 h (range 1-144 h).
Results:
Fifty-six patients (81%) were transplanted. Nine died before they could be transplanted, and four patients recovered without transplantation. Forty-six (82%) of the transplanted patients were alive 30 days after transplantation. Ammonium decreased modestly from a median of 148 to 124 µM (p = 0.03) during MARS treatment. We detected worsening of coagulopathy with significant decreases in platelet count and fibrinogen concentrations, and increase in International Normalized Ratio. Phosphate and magnesium decreased significantly during MARS treatment.
Conclusion:
Continuous MARS therapy may bridge liver failure patients to LT under close observation and treatment of coagulopathy and electrolyte disturbances.
Insights
Molecular adsorbent recirculating system (MARS) therapy can bridge critically ill liver failure patients to liver transplantation (LT). Close monitoring of coagulopathy and electrolyte levels is crucial during MARS treatment.
Area of Science:
- Hepatology
- Nephrology
- Critical Care Medicine
Background:
- The molecular adsorbent recirculating system (MARS) is utilized for blood purification in liver failure patients, targeting albumin-bound toxins.
- Despite its use, randomized trials have not confirmed improved survival, and its clinical utility remains under investigation.
- MARS application in our department is reserved for the most critically ill patients with acute or acute-on-chronic liver failure.
Purpose of the Study:
- To evaluate the efficacy and outcomes of Molecular Adsorbent Recirculating System (MARS) therapy in patients with severe liver failure awaiting liver transplantation (LT).
Main Methods:
- Sixty-nine patients with liver failure awaiting LT were treated with MARS between 2005 and the present.
- Patients received MARS therapy at a flow rate of 35-40 mL/kg/h, with treatment kits exchanged every 8-12 hours.
- Treatment duration varied, with a median of 27 hours (range 1-144 hours).
Main Results:
- 81% of patients (56/69) were successfully transplanted.
- Of the transplanted patients, 82% (46/56) survived 30 days post-transplantation.
- MARS treatment led to a modest decrease in ammonium levels but caused significant worsening of coagulopathy and depletion of phosphate and magnesium.
Conclusions:
- Continuous MARS therapy can serve as a bridge to LT for patients with liver failure.
- Management requires vigilant monitoring and treatment of associated coagulopathy and electrolyte disturbances.
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