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MARS ® : a futile tool in centres without active liver transplant support
Author(s) -
Wai ChunTao,
Lim SengGee,
Aung MyotOo,
Lee YinMei,
Sutedja Dede S.,
Dan YockYoung,
Aw Marion M.,
Quak SengHock,
Lee Margaret K.,
Da Costa Maureen,
Prahbakaran K.,
Lee KangHoe
Publication year - 2007
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2006.01388.x
Subject(s) - medicine , randomized controlled trial , liver transplantation , liver failure , surgery , mars exploration program , sepsis , transplantation , physics , astronomy
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.