The effect of molecular absorbent recirculating system on pathophysiological parameters in patients with acute liver failure

Objective: To investigate the effect of the molecular adsorbent recirculating system (MARS) on physiological variables in patients with acute liver failure. Design: A prospective, observational study of MARS in addition to standard medical therapy in the management of patients presenting with acute liver failure. Setting: A regional liver transplant centre. Patients: Ten consecutive patients admitted with acute liver failure with a grade III or IV hepatic encephalopathy. Interventions: MARS therapy for 8 h on 2 consecutive days. Standard monitoring included the use of a pulmonary artery catheter and an intracranial pressure monitor. Measurements and results: During the first MARS treatment there was a significant increase in systemic vascular resistance index (SVRI) from 1114 +/- 196 to 1432 +/- 245 dyne s(-1) cm(-5) m(-2) with a reduction in cardiac index from 5.5 +/- 0.6 to 4.2 +/- 0.4 l min(-1) m(-2). The changes were maintained between the start of the first and second sessions but not to the end of second. Significant clearance of urea and creatinine was observed. Intracranial pressure did not change during the treatments. Overall mortality was 70%. Conclusions: MARS therapy was well tolerated, with significant increases in vascular tone during the first session. This increase was not sustained over the duration of the study with a return to baseline values by the end of the second session. Based on our experience we cannot recommend the routine use of MARS therapy in acute liver failure outside of a clinical trial.