PMID- 12220303
OWN - NLM
STAT- MEDLINE
DCOM- 20030423
LR  - 20190922
IS  - 0106-9543 (Print)
IS  - 0106-9543 (Linking)
VI  - 22 Suppl 2
DP  - 2002
TI  - MARS (Molecular Adsorbent Recirculating System): experience in 34 cases of acute 
      liver failure.
PG  - 43-7
AB  - As reported in the literature, the mortality rates for patients with Acute 
      Hepatic Failure (AHF) approaches 80% in cases in which liver transplantation is 
      not possible. Post-transplant mortality mostly depends on the severity of the 
      neurological condition at the time of the operation (20% in I-II degree coma 
      patients and 44% in III degree coma patients). The primary indications for liver 
      transplantation in AHF are Fulminant Hepatitis (FH)(93%), Subfulminant Hepatitis 
      (5%) and other indications (2%). Other causes of AHF are Primary Non-Function 
      (PNF) and Delayed Function (DF), which occur in 7-10%. Therefore it becomes 
      necessary to monitor the patients with a Liver Support Device to be able to 
      improve the clinical condition of the patients before liver transplantation (LT). 
      In our experience we used the Molecular Adsorbent Recirculating System (MARS) 
      (MARS Monitor; Teraklin AG, Rostock Germany), which enables the selective removal 
      of albumin-bound substances accumulating in liver failure by the use of 
      albumin-enriched dialysate. The system is used as a bridging device to orthotopic 
      liver transplantation (OLT) of patients with FHF. We studied 34 patients, 
      including 16 males and 18 females: 9 were affected by Primary-Non-Function (PNF), 
      nine by Fulminant Hepatitis (FH), six by Delayed-Non-Function (DNF), and ten by 
      Acute on Chronic Hepatic Failure (AOCHF). The average age of the patients was 
      41.8 years and the average number of applications was 6.4; the median length of 
      application was about eight hours. The parameters that we monitored, before and 
      after each treatment, were neurological status (EEG, cerebral CT, Glasgow Coma 
      Score), haemodynamic parameters, acid base equilibrium, and blood gas analysis. 
      We also monitored hepatic and renal function. In addition, the clinical 
      conditions of the patients were monitored using kidney and liver 
      ultrasound/ultrasonography (US). Inclusion criteria were bilirubin > 15 mg/dL, 
      ammonia > 160 micro g/dL and a Glasgow Coma Score between 6 and 11. The reduction 
      of bilirubin and ammonia were very significant (P < 0.01), whereas the changes of 
      International Normalized Ratio (INR) were not significant. Also the modifications 
      of albumin, total protein, sodium, potassium and calcium were not significant. In 
      conclusion, four out of nine patients with PNF are alive without a second 
      transplantation and were discharged after about 48 days; four out of nine 
      underwent OLT, while one out of nine died; five out of six patients with DF are 
      alive without a second transplantation, and they were discharged after an average 
      time of 55.5 days, one out of six died; six out of nine patients with fulminant 
      hepatitis underwent OLT and four of these are alive, while two died due to 
      sepsis; three patients are alive without OLT. Four patients with AOCHF underwent 
      OLT and are alive, three patients are alive and on a waiting list, two died while 
      on a waiting list and one patient who experienced reactivation of HBV infection 
      during chemotherapy for non-Hodgkin's lymphoma is alive. In spite of the limited 
      number of cases of our study, we believe that MARS can be applied with high 
      tolerance for a very long period of time. In addition, its repeatability allows 
      it to be used in patients with DNF and FH as a bridge to transplant. In patients 
      with DNF, it is used while waiting for complete recovery of the transplanted 
      organ.
FAU - Novelli, Gilnardo
AU  - Novelli G
AD  - II Department of Surgery-Service of Transplantation, University of Rome La 
      Sapienza, Italy. novelligilnardo@virgillio.it
FAU - Rossi, Massimo
AU  - Rossi M
FAU - Pretagostini, Renzo
AU  - Pretagostini R
FAU - Poli, Luca
AU  - Poli L
FAU - Novelli, Luigi
AU  - Novelli L
FAU - Berloco, Pasquale
AU  - Berloco P
FAU - Ferretti, Giancarlo
AU  - Ferretti G
FAU - Iappelli, Massimo
AU  - Iappelli M
FAU - Cortesini, Raffaello
AU  - Cortesini R
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - Denmark
TA  - Liver
JT  - Liver
JID - 8200939
RN  - 7664-41-7 (Ammonia)
RN  - RFM9X3LJ49 (Bilirubin)
SB  - IM
MH  - Adult
MH  - Ammonia/blood
MH  - Bilirubin/blood
MH  - Female
MH  - Hepatic Encephalopathy/blood/therapy
MH  - Humans
MH  - Liver Failure, Acute/blood/*therapy
MH  - Male
MH  - Middle Aged
MH  - *Renal Dialysis
MH  - *Sorption Detoxification
MH  - Treatment Outcome
EDAT- 2002/09/11 10:00
MHDA- 2003/04/24 05:00
CRDT- 2002/09/11 10:00
PHST- 2002/09/11 10:00 [pubmed]
PHST- 2003/04/24 05:00 [medline]
PHST- 2002/09/11 10:00 [entrez]
AID - 0008 [pii]
AID - 10.1034/j.1600-0676.2002.00008.x [doi]
PST - ppublish
SO  - Liver. 2002;22 Suppl 2:43-7. doi: 10.1034/j.1600-0676.2002.00008.x.