Fulminant Hepatic Failure Bridged to Liver Transplantation with a Molecular Adsorbent Recirculating System: A Single-Center Experience
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.
Key Wordsalbumin dialysis extracorporeal liver assist device fulminant hepatitis
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- 2.Jaregui HO: Cellular component of bioartificial liver support systems. Artif Organs 23(10):889–893, 1999Google Scholar
- 3.Mitzner SR, Stange J, Klammt S, Risler T, Erley CM, Bader BD, Berger ED, Lauchart W, Peszynski P, Freytag J, Hickstein H, Loock, J, Löhr JM, Liebe S, Emmrich J, Korten G, Schmidt R: Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial. Liver Transpl 6(3):277–286, 2000CrossRefPubMedGoogle Scholar
- 8.Doria C, Doyle HR, Mandalà L, Marino IR, Caruana G, Gruttadauria S, Lauro A, Magnone M, Scotti Foglieni C, Lamonaca V, Scott VL: Changes in serum electrolytes during treatment of patients in liver failure with molecular adsorbent recirculating system. Int J Artif Organs 26(10):918–923, 2003PubMedGoogle Scholar
- 10.Doria C, Mandalà L, Scott VL, Marino IR, Gruttadauria S, Miraglia R, Vitale CH, Smith J: Noncardiogenic pulmonary edema induced by molecular adsorbent recirculating system. Case report. J Artif Organs 6(4):282–285, 2003Google Scholar
- 16.Hughes RD, Nicolau N, Langley PG, Ellis AJ, Wendon JA, Williams R: Plasma cytokine levels and coagulation and complement activation during use of the extracorporeal liver assist device in acute liver failure. J Artif Organs 22(10):854–858, 1998Google Scholar
- 18.Falkenhagen D, Strobl W, Vogt G, Schrefl A, Linsberger I, Gerner FJ, Schoenhofen M. Fractionated plasma separation and adsorption system: a novel system for blood purification to remove albumin bound substances. J Artif Organs 23(1):81–86, 1999Google Scholar
- 19.Bismuth H, Figuerio J, Samuel D: What should we expect from a bioartificial liver in fulminant hepatic failure? J Artif Organs 22(1):26–31, 1998Google Scholar
- 24.Stange J, Mitzner SR, Risler T, Erley CM, Lauchart W, Goehl H, Klammt S, Peszynski P, Freytag J, Hickstein H, Löhr M, Liebe S, Schareck W, Hopt UT, Schmidt R: Molecular adsorbent recycling system (MARS): clinical results of a new membrane-based blood purification system for bioartificial liver support. J Artif Organs 23(4):319–330, 1999Google Scholar