Molecular Adsorbent Recirculating System Therapy for Acute Liver Failure: Institutional Indications
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GI and Nutrition, Research, 2022
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INTRODUCTION: Molecular Adsorbent Recirculating System (MARS) is an extracorporeal liver support system that removes water-soluble and albumin-bound toxins. We report our experience as one of the few North American centers that offers MARS for precise indications of acute liver failure (ALF) hypothesizing that the application of institutional criteria would be associated with higher-than predicted survival.
METHODS: Adults receiving MARS from 2015-2021 were analyzed. Institutional indications for MARS included acetaminophen intoxication (IT), pre-transplant candidates (PT), patients who were anatomically anhepatic and awaiting liver transplant (AH), post-transplant patients with primary graft non-function (GNF), and patients with reversible forms of multiple organ failure (MOF). Data were analyzed with parametric and non-parametric statistics as indicated. Standardized mortality ratios (SMR) were calculated for each indication.
RESULTS: Sixty one patients underwent MARS; 19.6% for IT, 70.5% PT, 8.2% AH, 16.4% GNF, and 16.8% MOF. Patients had a median of 2 sessions (IQR, 2-3), each lasting 8 hours. The median Model for End-stage Liver Disease-Sodium (MELD-Na) score was 33 (IQR, 25-40), and the mean SOFA score was 13.4 (±4.1) indicating an expected mortality of over 50% for the entire cohort. Actual survival at 30 days was 60.7%. MARS was associated with significant median decreases in INR (3.2 vs 1.5), creatinine (2.0 vs. 1.05 mg/dL), ALT (1681 vs. 347 U/L), AST (3334 vs. 344 U/L), ammonia (58 vs. 39 unmold/L), lactate (7.8 vs. 2.4 mmol/L) and norepinephrine dose (0.21 vs. 0.06 mcg/kg/min). Eighteen patients (29.5%) required a liver transplant with 78% surviving to hospital discharge. Significantly higher than expected survival was observed for PT (SMR 0.78; 95% CI, 0.63-0.93) and GNF (SMR 0.58; 95% CI, 0.32-0.84).
CONCLUSION: We report one of the largest single-center north American series of ALF patients treated with MARS. Using institutional criteria and a multidisciplinary approach, a higher than expected survival rate was observed. MARS can improve laboratory parameters, allow time for hepatic recovery, and avert liver transplantation. These data add to a growing body of literature in support of MARS therapy and motivateadditional clinical trials to determine greatest benefit.
Meta Tag
Content Type Presentation
Knowledge Area Research
Knowledge Area GI and Nutrition
Knowledge Area Pharmacology
Knowledge Level Advanced
Membership Level Select
Tag Liver
Tag Outcomes Research
Tag Toxicology
Year 2022
Molecular Adsorbent Recirculating System
MARS therapy
Acute Liver Failure
toxin removal
hepatic recovery


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