A Retrospective Study on the Effect of Molecular Adsorbent Recirculating System in Patients with Liver Failure

Abstract

Background: Liver failure (LF) is associated with a high mortality rate, requiring a liver transplant as the definitive treatment. The Molecular Adsorbent Recirculating System (MARS) is a non-biologic system that removes toxic metabolites from the bloodstream by providing extracorporeal support while waiting for a liver transplant. Conflicting pieces of evidence from multiple studies are present regarding the outcome of MARS therapy. We evaluated the effect of MARS therapy on patients with liver failure by measuring the changes in their laboratory parameters. Methods: In this retrospective cohort analysis, we evaluated 44 patients, by comparing relevant laboratory variables measured before and after MARS therapy. Paired t-test was used for statistical analysis. The primary outcome was an improvement in laboratory parameters following MARS therapy. Results: Most of our study cohort were females (63.64%) and white (72.72%). The predominant causes of liver failure were NASH (non-alcoholic steatohepatitis) (22.73%) and alcoholism (22.73%). At admission, the mean Child-Pugh score was 11.45 (SD: 1.97), and the mean SOFA (sequential organ failure assessment) score was 10.95 (SD: 3.65). The mean number of MARS sessions was 4.32 (SD: 2.28) and the mean duration for patients on MARS therapy was 4.64 days (SD: 2.44). Our analysis demonstrates a statistically significant improvement in mean serum bilirubin, ammonia, urea, creatinine, ALT, and AST levels following MARS therapy. The mean model for end-stage liver disease (MELD-Na) scores also significantly improved. 59.09% of our total patient population survived the hospital stay and 40.91% died in hospital, with 73.07% of the survivors eventually receiving a liver transplant. 94.74% of the patients with whom we were able to bridge MARS therapy until liver transplant, had survived through the follow-up period. Conclusion: Our study findings suggest that MARS improves the liver-failure-associated laboratory parameters and may be effective therapy as a bridge to liver transplant.