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Replacement therapy bridges recovery gap in acute liver failure

Molecular adsorbent recirculating system therapy, or MARS, successfully replaced hepatic function in patients with acute liver failure, which may provide support during recovery or prior to transplantation.

“MARS therapy seems to improve the biochemical parameters,” Thomas M. Scalea, MD, the Honorable Francis X. Kelly Distinguished Professor of Trauma Surgery and director of the program in trauma at the University of Maryland School of Medicine, said in a press release. “In people with significant biochemical abnormalities that have a potentially reversible cause of their liver failure, or who are considered good candidates for transplant, it seems like a good idea.” Scalea advised, however, that MARS is not particularly useful in patients with multiple organ failure.

Twenty-seven adult patients with acute liver failure underwent MARS therapy. This included five patients with severe liver failure, nine patients with toxic liver injury and 13 patients who required liver transplantation.

Following treatment, the researchers observed improvements in international normalized ratio (2.2 vs. 3.62; P < .01), creatinine (1.32 vs. 2.21 mg/dL; P < .01), alanine aminotransferase (2,621.74 vs. 6,177.61; P < .01) and aspartate aminotransferase (1,249.05 vs. 2,905.8; P < .01), fraction of inspired oxygen (42.33 vs. 53.58; P = .02), APACHE II score (23.05 vs. 27; P < .02) and a lower percentage of encephalopathy (15% vs. 17%; P < .01) compared with baseline. Overall patient survival was 59.3% with no significant difference between cause of liver injury.

Of the five patients with severe liver injury, three survived and underwent hepatic resection and two died. Nine of the 13 patients requiring liver transplantation with evidence of massive hepatic necrosis received liver transplant and had a 1-year survival rate of 78%. Nine patients who received MARS therapy for toxic ingestion had a 30-day survival of 75%.

“The utility of liver replacement therapy in the ALF patient secondary to multiple causes remains controversial,” Scalea and colleagues wrote. “The real benefit of this technology may be in its ability to support the patient through the initial insult, allows the intensivist to stabilize the patient, and temporize the multisystem organ dysfunction caused by the variety of toxins released in the setting of ALF.” – by Talitha Bennett

Disclosure: The researchers reported no relevant financial disclosures.