Molecular adsorbents recirculating system in patients with severe liver failure. Experience of a single Romanian centre

Abstract

Aim: This is a retrospective, observational study regarding the experience of the Fundeni Clinical Institute in the application of the Molecular Adsorbents Recirculating System in patients with liver failure.

Method: From January 2002 until December 2007, we performed 50 MARS sessions in 27 patients, mean age 38.96+/-19.58 years. The etiology of liver failure was as follows: acute liver failure (ALF) in 7 patients, acute-on-chronic liver failure (AoCLF) in 10 patients, post-liver transplantation in 8 patients, and post-hepatectomy in 2 patients.

Results: We noticed the following clinical effects: improvement in general condition, in neurological status, marked regression of jaundice and pruritus, improvement in renal function and in hemodynamic status. Of the 7 patients with ALF, 3 patients (42.8 %) survived due to their own liver recovery. Only 2 patients (20%) with AoCLF survived. In this group, one patient was transplanted, one patient is alive, and the mean survival of the remaining patients was 24.5+/-34.6 days. In the post-liver transplantation group, one patient was retransplanted, one patient is alive and the mean survival of the other 6 patients was 28.5+/-39.8 days. One patient with post-hepatectomy liver failure presented spontaneous liver recovery.

Conclusion: MARS therapy was well tolerated by the patients. MARS therapy efficiently removed water soluble and albumin-bound toxins. The unfavorable prognostic factors were the association with multi organ failure and sepsis.