Molecular Adsorbent Recycling system (MARS) for acute on chronic alcoholic hepatitis: a case report

A 37-year old patient was admitted to the hepatology unit because of progressive jaundice, pyrosis and weight loss. He had a history of alcohol abuse (varying between 30 - 90 g per day) for more than 15 years. On admission, imaging studies (echography, CT and NMR scans) revealed marked hepatomegaly and ascites without clear-cut arguments for cirrhosis. Relevant biochemical parameters are summarised below. He was diagnosed with acute on chronic alcoholic hepatitis. On 17/3 he was admitted to the MICU because of progressive renal failure, encephalopathy grade I, and increasing biochemical signs of inflammation. He did not fulfil criteria for a diagnosis of hepatorenal syndrome, extensive investigations for infection were negative.

Table 1Course of blood chemical data during a series of MARS treatments in a 37 year old patient with acute decompensation of chronic liver dysfunction Admission 10/3 Admission MICU 17/3 MARS 5/4 MARS 6/4 MARS 7/4 MARS 11/4 MARS 12/4 Home 4/5 alk. phosph. 451 U/l 321 640 523 457 395 351 246 AST 98 U/l 102 67 73 62 69 62 48 ALT 48 U/l 30 21 19 16 25 25 39 gamma-GT 258 U/l 168 162 117 98 105 95 103 bilirubin 24.6 mg/dl 23.5 35.1 22.6 18.8 16.3 13.4 4.8 bile acids - µmol/l - 236 135 64 101 - - creatinine 1.56 mg/dl 7.1 1.9 1.3 0.98 1.5 1.0 1.6 PT 28 % 21 % 38 % 42 % 54 % 54 % 52 % 69 %

Volume replacement and 2 sessions of kidney dialysis helped to improve kidney function. However, over the next 2 weeks there was a progressive deterioration of excretory liver function and cognition with dismal prognosis. The patient underwent 5 sessions of MARS treatment of 12 hours duration each with on only 2 occasions a kidney filtration volume of 500 ml. Already after the first session there was a clear and sustained improvement of cognition and a clear decrease in slurred speech, sleepiness, and asterixis. The biochemical improvements were spectacular (see table [1]). The patient was discharged home 10 weeks after the initial admission.

This case report adds to the growing body of evidence that MARS treatment can be life-saving for patients with acute on chronic liver dysfunction.