Efficacy of MARS in 3 patients with Hepatorenal symdrome and hepatic encephalopathy: first experience in Spain

Hepatorenal syndrome (HRS) and hepatic encephalopathy (HE) represent critical situations with high mortality rates. Recently a new therapy has been developed: MARS (Molecular Adsorbent Recirculating System). In this study we present our experience with MARS in 3 patients affected with HRS and HE.

We established a clinical protocol and specific indications for MARS use. During a period of 4 months we included 3 patients. In all of them we performed a clinical evaluation and determined biochemical parameters before and after each MARS session and after the period of treatment. There were no hypotensive episodes during MARS treatment. All the patients showed an improvement of clinical parameters (ie: pruritus, HE). Among biochemical data, total bilirubin showed the most important decrease. After the treatment period 2 patients showed an increase of the creatinine levels.

Table 1 Clinical and biochemical data before MARS * Patient # 1 Patient # 2 Patient # 3 Age/Gender 30 ys/Female 40 ys/Male 66 ys/Female Diagnosis Autoimmune Hep. Acute Alcoh. Hept. PBC MARS indication Pruritus and Bi HRS and HE HRS and HE Child-Pugh/HE -/0 -/III C-15/III Total Bi/PT 36.8/64 % 36.8/51 % 40/22 % Scr/NH4 1.23/35 5.2/85 1.2/74 Bi: bilirubin (mg/dl); PT: prothrombin time (%); Scr: serum creatinine (mg/dl); NH4: amonium (mg/dl); PBC: primary billiary chirrosis.

Table 2 Clinical and biochemical data after MARS * Patient # 1 Patient # 2 Patient # 3 N°sess/hours ses 4/8 4/8 4/8 Child-Pugh/HE -/0 -/I C-13/0 Total Bi/PT 15.1/55 % 13.6/48 % 24.4/38 % Scr/NH4 2.26/36 2.01/75 4.2/40 Clinical evolution OLT exitus-sepsis waiting list OLT: orthotopic liver transplant.

We conclude: MARS represents an interesting therapeutic alternative in patients with advanced hepatic failure; patients that underwent MARS showed a clinical and biochemical improvement that permitted their inclusion in liver transplant waiting list. Surprisingly, there was a deterioration of kidney function in two patients. Multicentric studies are needed that could answer some of the questions related to this new treatment.