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Systematic review of MARS treatment in post-hepatectomy liver failure
Ernesto Sparrelid1, Stefan Gilg1, Thomas M van Gulik2
1Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Background:
Post-hepatectomy liver failure (PHLF) remains a serious complication after major liver resection with severe 90-day mortality. Molecular adsorbent recirculating system (MARS) is a potential treatment option in PHLF. This systematic review sought to analyze the experiences and results of MARS in PHLF.
Methods:
Following the PRISMA guidelines, a systematic literature review using PubMed and Embase was performed. Non-randomized trials were assessed by the MINORS criteria.
Results:
2884 records were screened and 22 studies were extracted (no RCT). They contained 809 patients including 82 patients with PHLF. Five studies (n = 34) specifically investigated the role of MARS in patients with PHLF. In these patients, overall 90-day survival was 47%. Patients with primary PHLF had significantly better 90-day survival compared to patients with secondary PHLF (60% vs 14%, p = 0.03) and treatment was started earlier (median POD 6 (range 2-21) vs median POD 30 (range 15-39); p < 0.001). Number of treatments differed non-significantly in these groups. Safety and feasibility of early MARS treatment following hepatectomy was demonstrated in one prospective study. No major adverse events have been reported.
Conclusion:
Early MARS treatment is safe and feasible in patients with PHLF. Currently, MARS cannot be recommended as standard of care in these patients. Further prospective studies are warranted.
Insights
Early Molecular Adsorbent Recirculating System (MARS) treatment shows safety and feasibility for post-hepatectomy liver failure (PHLF). While survival rates are promising, MARS is not yet standard care, necessitating further research.
Area of Science:
- Hepatology
- Gastroenterology
- Critical Care Medicine
Background:
- Post-hepatectomy liver failure (PHLF) is a severe complication with high mortality after major liver resection.
- Molecular Adsorbent Recirculating System (MARS) presents a potential therapeutic option for PHLF management.
Purpose of the Study:
- To systematically review and analyze the experiences and outcomes of using MARS in patients with PHLF.
Main Methods:
- A systematic literature review was conducted following PRISMA guidelines, searching PubMed and Embase.
- Non-randomized trials were evaluated using the Methodological Index for Non-Randomized Studies (MINORS) criteria.
- Data from 22 extracted studies, including 809 patients (82 with PHLF), were analyzed.
Main Results:
- Five studies specifically focused on MARS in 34 PHLF patients, reporting a 47% overall 90-day survival.
- Primary PHLF patients demonstrated significantly better 90-day survival (60%) compared to secondary PHLF (14%) with earlier MARS initiation.
- Early MARS treatment was found to be safe and feasible, with no major adverse events reported in a prospective study.
Conclusions:
- Early initiation of MARS treatment is safe and feasible for patients experiencing PHLF.
- Current evidence does not support recommending MARS as standard of care for PHLF.
- Further prospective research is essential to establish the definitive role of MARS in PHLF treatment.
