Mars therapy as a bridge to liver transplantation

Background: Different artificial liver support systems are being developed for use in patients with acute decompensation of chronic liver disease or acute liver failure. Molecular adsorbents recalculating system (MARS) is a liver support system based on albumin dialysis.

Aims: To evaluate our experience with MARS therapy in the national liver transplant unit

Methods: In this retrospective study we evaluated charts of eight patients (five males, three females) with different etiologies for decompensated chronic liver disease (two alcoholic, four post transplant liver failure, one hepatitis C virus, one alpha1antitrypsin deficiency) that were supported with MARS in a period from Feb 2002– Feb 2005. Patient's age, sex, indication for MARS support, number of sessions and outcome were studied.

Results: In this study involving eight patients (age 18–60 years) were treated with MARS in average 3–6 sessions. We found that 3/8 (37.5%) had improved, bilirubin ,creatinine and INR all improved in all patients. Three patients subsequently had successful liver transplantation (2 retransplants). Two of the three had sustained improvements in hepatic encephalopathy following MARS therapy. The other 5(62.5%) patients had transient biochemical improvements but subsequently died.

Conclusions: MARS may be effective in selected patients as a bridge to liver transplantation or re-transplantation.