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2015 ; 50
(9
): 1127-34
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Continuous molecular adsorbent recirculating system treatment in 69 patients
listed for liver transplantation
#MMPMID25865318
Olin P
; Hausken J
; Foss A
; Karlsen TH
; Melum E
; Haugaa H
Scand J Gastroenterol
2015[]; 50
(9
): 1127-34
PMID25865318
show ga
OBJECTIVE: The molecular adsorbent recirculating system (MARS) is used to purify
blood from albumin-bound toxins in patients with liver failure. However, the
application of MARS has not demonstrated improved survival in randomized clinical
trials and the clinical utility has not been finally established. In our
department, the use of MARS is now restricted to the most critically ill patients
with acute or acute on chronic liver failure. MATERIAL AND METHODS: Since 2005,
we have treated 69 patients (30 males/39 females with median age of 49 years
ranging from 1 months to 70 years) listed for liver transplantation (LT) with
MARS. Median model of end-stage liver disease score in patients older than 12
years of age (n = 56) was 33 (interquartile range 26-39). The flow rate was 35-40
mL/kg/h and treatment kits were changed every 8-12 h. The patients were treated
for a median of 27 h (range 1-144 h). RESULTS: Fifty-six patients (81%) were
transplanted. Nine died before they could be transplanted, and four patients
recovered without transplantation. Forty-six (82%) of the transplanted patients
were alive 30 days after transplantation. Ammonium decreased modestly from a
median of 148 to 124 µM (p = 0.03) during MARS treatment. We detected worsening
of coagulopathy with significant decreases in platelet count and fibrinogen
concentrations, and increase in International Normalized Ratio. Phosphate and
magnesium decreased significantly during MARS treatment. CONCLUSION: Continuous
MARS therapy may bridge liver failure patients to LT under close observation and
treatment of coagulopathy and electrolyte disturbances.