Use of MARS in the Treatment of Acute Liver Failure: Preliminary Monocentric Experience

As reported in the literature, the mortality rate for patients with Acute Hepatic Failure (AHF) approaches 80 % in cases in which liver transplantation is not possible.

Post transplant mortality depends on the seriousness of the neurological condition at the time of the operation (20 % in I-II degree coma patients and 44 % in III degree coma patients). This is the rationale for extracorporeal depuration treatment, as a bridge to transplantation, both in AHF and in Primary Non Function (PNF) cases.

The recirculating molecular adsorption system (MARS), whose only function is to depurate through a ”hybrid“ membrane removing toxic substances related to albumin, has advantage in that it can be used for long periods. The aim of this study is to report on our experience in the use of MARS on 10 AHF patients (4 PNF, 2 delayed non function, 4 fulminant hepatitis). The average age was 41,8 years (range 23-56), 6 were male, 4 female. All had bilirubin ≥ 15 mg/dl and ammonia ≥ 160 µg/dl. MARS was applied for 8 ± 1,5 hours a day. The average number of treatments was 6,4 (range 1-24).

The EEG, hepatic and renal parameters were monitored before and after the treatment, while the hemodynamic parameters were monitored during the treatment.

No hemodynamic complications occured during the treatment. A significant reduction in bilirubin (p < 0,01) and ammonia (p < 0,01) was observed. the average INR level at the onset of treatment was 2,05, at the end 1,59. After the treatment there was an improvement in neurological conditions. Three of the PNF patients recovered function of the transplanted organ and survived without further transplantations. The same applies for the two patients with delayed non function. All fulminant hepatitis patients were successfully bridged to transplantation, three subsquently died from complications, one was discharged in good condition.

On the basis of our preliminary studies, the MARS treatment was found to be safe with a high tolerance rate, having a role in AHF treatment as bridge to liver transplantation or waiting for the graft to recover its functionality.

Correspondence