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Molecular Adsorbent Recirculating System (MARS) Effectively Replaces Hepatic Function in Severe Acute Liver Failure (ALF)
Steven I Hanish1, Rolf N Barth1, Deborah M Stein2, Eno-obong Essien1, Paul Thurman2, Stephen T Bartlett1, Thomas M Scalea2
1University of Maryland School of Medicine, Baltimore, MD;2R Adams Cowley Shock Trauma Center, Baltimore, MD

Introduction:
Patients with severe ALF have extreme physiologic dysfunction and often die if transplantation is not immediately available. Patients may be supported with MARS (R, Gambro) until transplant or spontaneous recovery occurs. We present the largest US series of MARS therapy as temporary hepatic replacement for ALF.
Methods:
Data was analyzed from a Level One trauma center and large liver transplant center that has cared for over 1000 hepatic transplant recipients. MARS was used as bridge to transplant (BTT), definitive therapy for toxic ingestion (DT), and in severe liver trauma (SLT). Patient demographics, etiology of ALF, and laboratory values were recorded. End-points were patient survival +/- liver transplant and/or recovery of liver function.
Results:
27 patients with severe ALF received MARS therapy. Mean MELD of the MARS group was 37 vs. 27 for total transplant program. 5 patients with SLT had a 60% survival with recovery of liver and renal function. 12 patients received MARS as a BTT. 8 received liver transplantation with a 1 yr survival of 88% (program overall survival 85% at 1 year). All 4 non-transplanted expired. 10 patients with ALF from toxic ingestion received MARS as DT with liver recovery and survival in 60%. Ammonia and INR significantly improved during MARS therapy (p<0.05, 0.01). No one suffered cerebral herniation during MARS therapy.
Conclusion:
MARS therapy successfully replaces hepatic function in ALF allowing time for spontaneous recovery or transplantation. Spontaneous recovery was remarkably common if support can be sustained with optimized critical care and MARS therapy.


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