Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation

Objective: To assess the usefulness of dialysis with the molecular adsorbent recirculating system (MARS) in patients with acute liver failure who fulfil criteria for liver transplantation. Design: Observational cohort study. Setting: ICU at a liver transplantation centre. Patients: Twenty-two patients (23 episodes) received MARS dialysis. They were either listed for LT (n = 14), delayed (n = 1), or not listed (contra-indication, n = 7). Interventions: A total of 56 MARS treatments (median per patient 2; mean duration 7.6 +/- 2.6 h) were performed on haemodialysis. Measurements and results: Clinical and biological variables were assessed before and 24 h after MARS therapy. The rate of recovery of liver function without transplantation was compared with an expected rate and survival was analysed. Following MARS dialysis, we observed an improvement in the grade of hepatic encephalopathy (P = 0.02) and the Glasgow coma score (P = 0.02), a decrease in conjugated bilirubin (P = 0.05) and INR (P = 0.006), and an increase in prothrombin index (P = 0.005). Overall, liver function improved in seven patients (32%): four listed patients in whom transplantation could be avoided and three patients among those not listed due to contra-indications. The transplant-free recovery rate in listed patients was 29% (vs. expected 9%, P = 0.036). Listed patients (n = 14) had a higher 30-day survival rate [86% (12/14) vs 38% (3/8), P = 0.05] and a higher long-term survival rate (P = 0.02). Conclusions: A statistically significant improvement of liver function was observed after MARS therapy. Transplant-free recovery was more frequent than expected. The apparent benefit of MARS dialysis to treat acute liver failure needs to be confirmed by a controlled study.