Role of the molecular adsorbent recycling system (MARS) in the treatment of patients with acute exacerbation of chronic liver failure

Objective: To test the efficacy of the molecular adsorbent recycling system (MARS) in patients with acute exacerbation of chronic liver disease. Design: A prospective case analysis. Setting: A university-affiliate tertiary medical center. Patients and Methods: We applied MARS to treat a consecutive series of eigh t patients with acute exacerbation of chronic liver disease. Results: The overall survival rate was 62.5%. All patients demonstrated imp rovement with regard to their degree of encephalopathy. In three patients, intracranial pressure and jugular bulb oxygen saturation decreased and cere bral perfusion pressure increased after treatment institution. Patients' hy perdynamic state was attenuated, as demonstrated by elevation of systemic v ascular resistance, mean arterial pressure, and parallel reduction in cardi ac index. A prompt reduction in serum ammonia, bilirubin, and lactate level s was observed. There were no complications during the treatment period. Conclusions: Applying MARS treatments to patients with acute exacerbation o f chronic liver disease can detoxify blood, improve cerebral circulation, a nd reduce brain edema, as reflected by the reduction in intracranial pressu re and jugular bulb oxygen saturation values in our patients. A partial rev ersal of the characteristic hyperdynamic circulation was also achieved, Des pite our encouraging results, further testing is needed to determine the re liability of the system.