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Z Gastroenterol 2001; 39: 42
DOI: 10.1055/s-2001-919034
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© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

The effect of the molecular adsorbent recycling system (mars) on cerebral perfusion in patients with acute on chronic liver failure and hepatic encephalopathy

L. E. Schmidt1 , L. B. Svendsen1 , V. R. Sørensen2 , S. R. Mitzner3 , B. A. Hansen1 , F. S. Larsen1
  • 1Anesthesia, and
  • 2Nephrology, Depts of Hepatology Rigshospitalet, University Hospital, Copenhagen, Denmark, and
  • 3Dept. of Nephrology, Rostock University Hospital, Germany
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Publikationsdatum:
07. Oktober 2005 (online)

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Background and purpose: In patients with acute on chronic liver failure (AOCLF), hepatic encephalopathy (HE) may be caused by albumin-bound as well as water-soluble neuroinhibitory factors that are not cleared by the failing liver. In this study we aimed to determine if removal of such „neurotoxins” by MARS treatment would increase cerebral perfusion in patients with AOCLF and alleviate HE.

Patients and methods: Eight patients (median age 44, range 35-52 years) admitted with AOCLF due to alcoholic hepatitis (n = 6), bleeding from oesophageal varices (n = 1), and spontaneous peritonitis (n = 1). All patients were Child’s grade C. Six patients were encephalopathic. A single MARS treatment of 10 hours was performed and HE was graded according to the Fogarthy criteria before and after MARS treatment. Cerebral perfusion was determined by transcranial Doppler as mean flow velocity (Vmean) in the mean cerebral artery. Arterial pressure was monitored using a radial artery catheter. Arterial ammonia was monitored as a measure of MARS’ capability of removing toxins related to HE. Non-parametric statistics (Wilcoxon) were applied for analysis.

Results: Four patients, including three with hepatic encephalopathy, recovered. HE grade improved in three patients and remained unchanged in five (median 2 (0-3) vs. 1 (0-2), p = 0.11). During MARS treatment, Vmean increased from 42 (26-59) to 72 (52-106) cm/sec (p < 0.05), mean arterial pressure from 67 (57-83) to 76 (68-84) mm Hg (p < 0.05), while arterial ammonia decreased from 88 (45-117) to 71 (26-98) µmol/L (p < 0.05).

Conclusions: MARS treatment of patients with AOCLF improves cerebral perfusion and significantly reduces the arterial ammonia concentration. We speculate that liver dialysis by MARS removes meuroinhibitory factors, which result in improvement of cerebral blood flow and neurological status.

* This abstract was supported by a grant provided by Teraklin AG, Rostock, Germany.