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Fulminant Hepatic Failure Bridged to Liver Transplantation with a Molecular Adsorbent Recirculating System: A Single-Center Experience

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Abstract

We herein describe the clinical course of a consecutive series of fulminant hepatic failure patients treated with a molecular adsorbent recirculating system (MARS), a cell-free albumin dialysis technique. From November 2000 to September 2002, seven adult patients ages 22–61 (median, 41), one male (14.2%) and six females (85.7%), affected by fulminant hepatic failure underwent seven courses (one to five sessions each, 6 hr in duration) of extracorporeal support using the MARS technique. Pre- and posttreatment blood glucose, liver function tests, ammonia, arterial lactate, electrolytes, hemodynamic parameters, arterial blood gases, liver histology, Glasgow Coma Scale, and coagulation studies were reviewed. No adverse side effects such as generalized bleeding on noncardiogenic pulmonary edema, often seen during MARS treatment, occurred in the patients included in this study. Six patients (85.7%) are currently alive and well, and one (14.2%) died. Four patients (57%) were successfully bridged (two patients in 1 day and two other patients in 4 days) to liver transplantation, while two (5%) recovered fully without transplantation. All the measured variables stabilized after commencement of the MARS. No differences were noted between the pre- and the post-MARS histology. We conclude that the MARS is a safe, temporary life support mechanism for patients awaiting liver transplantation or recovering from fulminant hepatic failure.

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Authors and Affiliations

  1. Transplant Division, Department of Surgery, Jefferson Medical College–Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, 19107, USA

    Cataldo Doria MD & Ignazio R. Marino MD

  2. Department of Surgery, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT–UPMC, Palermo, Italy

    Lucio Mandalá MD & Salvatore Gruttadauria MD

  3. Department of Anesthesiology, Maricopa Medical Center, Phoenix, Arizona, 85008, USA

    Victor L. Scott MD

  4. Transplant Division, Jefferson Medical College–Thomas Jefferson University Hospital, 1025 Walnut Street, Suite 605 College Building, Philadelphia, Pennsylvania, 19107, USA

    Cataldo Doria MD

Authors
  1. Cataldo Doria MD
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  2. Lucio Mandalá MD
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  3. Victor L. Scott MD
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  4. Salvatore Gruttadauria MD
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  5. Ignazio R. Marino MD
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Correspondence to Cataldo Doria MD.

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Doria, C., Mandalá, L., Scott, V.L. et al. Fulminant Hepatic Failure Bridged to Liver Transplantation with a Molecular Adsorbent Recirculating System: A Single-Center Experience. Dig Dis Sci 51, 47–53 (2006). https://doi.org/10.1007/s10620-006-3115-1

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  • DOI: https://doi.org/10.1007/s10620-006-3115-1

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