Molecular Adsorbent Recirculating System Effectively Replaces Hepatic Function in Severe Acute Liver Failure

Steven I. Hanish, Deborah M. Stein, Joseph R. Scalea, Eno Obong Essien, Paul Thurman, William R. Hutson, Stephen T. Bartlett, Rolf N. Barth, Thomas M. Scalea

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Summary Background Data: Patients with severe acute liver failure (ALF) have extreme physiologic dysfunction and often die if transplantation is not immediately available. Patients may be supported with MARS (Baxter International Inc., Deerfield, IL) until transplantation or spontaneous recovery occurs. We present the largest series in the United States of MARS therapy as temporary hepatic replacement for ALF. Methods: MARS was used to support patients with severe liver trauma (SLT), in ALF patients as a bridge to transplantation (BTT), and as definitive therapy for toxic ingestion or idiopathic liver failure (DT) in a level 1 trauma center and large transplant center. Patient demographics, etiology of ALF, and laboratory values were recorded. Endpoints were patient survival ± liver transplant and/or recovery of liver function. Results: Twenty-seven patients with severe ALF received MARS therapy. Five patients with SLT had a 60% survival with recovery of liver and renal function. Thirteen patients received MARS as a BTT, of which 9 were transplanted with a 1-year survival of 78% (program overall survival 85% at 1 year). All 4 who were not transplanted expired. Nine patients with ALF from toxic ingestion received MARS as DT with liver recovery and survival in 67%. MARS therapy resulted in significant improvement in liver function, coagulation, incidence of encephalopathy, and creatinine. Conclusions: MARS therapy successfully replaced hepatic function in ALF allowing time for spontaneous recovery or transplantation. Spontaneous recovery was remarkably common if support can be sustained.

Original languageEnglish (US)
Pages (from-to)677-684
Number of pages8
JournalAnnals of surgery
Volume266
Issue number4
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

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Acute Liver Failure
Liver
Transplantation
Survival
Poisons
Eating
Transplants
Therapeutics
Trauma Centers
Recovery of Function
Liver Failure
Wounds and Injuries
Brain Diseases
Creatinine
Demography
Kidney

Keywords

  • critical care
  • extracorporeal liver support
  • liver failure
  • MARS

ASJC Scopus subject areas

  • Surgery

Cite this

Molecular Adsorbent Recirculating System Effectively Replaces Hepatic Function in Severe Acute Liver Failure. / Hanish, Steven I.; Stein, Deborah M.; Scalea, Joseph R.; Essien, Eno Obong; Thurman, Paul; Hutson, William R.; Bartlett, Stephen T.; Barth, Rolf N.; Scalea, Thomas M.

In: Annals of surgery, Vol. 266, No. 4, 01.10.2017, p. 677-684.

Research output: Contribution to journalArticle

Hanish, SI, Stein, DM, Scalea, JR, Essien, EO, Thurman, P, Hutson, WR, Bartlett, ST, Barth, RN & Scalea, TM 2017, 'Molecular Adsorbent Recirculating System Effectively Replaces Hepatic Function in Severe Acute Liver Failure', Annals of surgery, vol. 266, no. 4, pp. 677-684. https://doi.org/10.1097/SLA.0000000000002361
Hanish, Steven I. ; Stein, Deborah M. ; Scalea, Joseph R. ; Essien, Eno Obong ; Thurman, Paul ; Hutson, William R. ; Bartlett, Stephen T. ; Barth, Rolf N. ; Scalea, Thomas M. / Molecular Adsorbent Recirculating System Effectively Replaces Hepatic Function in Severe Acute Liver Failure. In: Annals of surgery. 2017 ; Vol. 266, No. 4. pp. 677-684.
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AB - Summary Background Data: Patients with severe acute liver failure (ALF) have extreme physiologic dysfunction and often die if transplantation is not immediately available. Patients may be supported with MARS (Baxter International Inc., Deerfield, IL) until transplantation or spontaneous recovery occurs. We present the largest series in the United States of MARS therapy as temporary hepatic replacement for ALF. Methods: MARS was used to support patients with severe liver trauma (SLT), in ALF patients as a bridge to transplantation (BTT), and as definitive therapy for toxic ingestion or idiopathic liver failure (DT) in a level 1 trauma center and large transplant center. Patient demographics, etiology of ALF, and laboratory values were recorded. Endpoints were patient survival ± liver transplant and/or recovery of liver function. Results: Twenty-seven patients with severe ALF received MARS therapy. Five patients with SLT had a 60% survival with recovery of liver and renal function. Thirteen patients received MARS as a BTT, of which 9 were transplanted with a 1-year survival of 78% (program overall survival 85% at 1 year). All 4 who were not transplanted expired. Nine patients with ALF from toxic ingestion received MARS as DT with liver recovery and survival in 67%. MARS therapy resulted in significant improvement in liver function, coagulation, incidence of encephalopathy, and creatinine. Conclusions: MARS therapy successfully replaced hepatic function in ALF allowing time for spontaneous recovery or transplantation. Spontaneous recovery was remarkably common if support can be sustained.

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