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- Title
MARS<sup>®</sup>: a futile tool in centres without active liver transplant support.
- Authors
Wai, Chun-Tao; Lim, Seng-Gee; Aung, Myot-Oo; Lee, Yin-Mei; Sutedja, Dede S.; Dan, Yock-Young; Aw, Marion M.; Quak, Seng-Hock; Lee, Margaret K.; Da Costa, Maureen; Prahbakaran, K.; Lee, Kang-Hoe
- Abstract
Background and aim: Studies on Molecular Adsorbent Recycling Systems (MARS®) showed inconclusive survival benefits. Patients and method: We evaluated the efficacy of MARS® for patients with either acute liver failure (ALF) or acute-on-chronic liver failure (AoCLF) at our centre, from February 2002 till April 2006 retrospectively. Results: Fifty ALF patients underwent median (range) three (1–10) sessions of MARS®. Acute exacerbations of chronic hepatitis B ( n=26) and drug-induced liver injury ( n=12) were the commonest causes. Living donors were available in 6, 2 paediatric patients underwent left lobe and four adults underwent right lobe living donor liver transplant. Among the 44 ALF patients without a suitable living donor, one underwent deceased donor liver transplant and survived, another 19-year-old male with acute exacerbations of chronic hepatitis B recovered without transplant, and the rest died. Twenty-six had AoCLF and underwent four (1–10) MARS® sessions. Sepsis ( n=16) and upper gastrointestinal bleeding ( n=4) were the commonest precipitating factors. None had a suitable living or deceased donor, suitable for transplantation during their hospitalization. Only one of 26 AoCLF patients survived the hospitalization, but the survivor died of sepsis 1 month later. Conclusion: In this non-randomized study, survival after MARS® was related to the availability of transplant, and in patients where living or deceased donor transplant was unavailable, MARS® was of little benefit. Randomized-controlled trials on MARS® are urgently needed to clarify its clinical utility.
- Subjects
LIVER failure; LIVER transplantation; HEPATIC encephalopathy; CIRRHOSIS of the liver; DIALYSIS (Chemistry)
- Publication
Liver International, 2007, Vol 27, Issue 1, p69
- ISSN
1478-3223
- Publication type
Article
- DOI
10.1111/j.1478-3231.2006.01388.x