Albumin Dialysis with Mars in Post-Hepatectomy Liver Failure (PHLF): Experiences from Two HPB Centers

Gilg S

doi:10.4172/2161-1076.1000252

Abstract

Aim: To study the impact of molecular adsorbent recirculating system (MARS) treatment on the outcome of patients with post-hepatectomy liver failure (PHLF). Patients and methods: Records of all patients treated with MARS due to PHLF between January 2003 and December 2013 at the intensive care units of Karolinska University Hospital (KH), Stockholm, Sweden, and Hospital Clinic (HC), Barcelona, Spain, were reviewed retrospectively. Results: Thirteen patients with PHLF were treated with MARS. Four patients suffered from PHLF secondary to serious post-operative complications and none of them survived. The remaining nine patients fulfilled the 50:50 Balzan criteria for PHLF. In these patients, MARS was commenced on post-operative day (POD) 3-21 (median 8) with a median of three cycles per treatment (range 2-6). In four patients who survived 90 days the treatment was started on POD 7-19 (median 8) with a median of six treatment cycles (range 4-6). In the non-surviving secondary PHLF patients, MARS was started first on POD 17-39 (median POD 32) with a median of 2 completed treatment sessions (range 1-4). No specific complications related to the use of MARS were observed. Conclusion: The use of MARS in PHLF seems to be feasible and safe and may be a therapeutic option in primary PHLF. Our data suggest that in order to achieve beneficial effects, MARS treatment should be initiated as early as possible in patients with PHLF and a minimum of four consecutive MARS sessions should be administered. Prospective research protocols are needed to further investigate this hypothesis.

Highlights

The extent of liver resection and pre-existing liver disease, represent main determinants of the risk of postoperative complications [1,2,3]
In the early 1990 ́s a promising treatment modality for patients with liver failure was introduced in the form of an extra corporeal, albuminbased liver-dialysis system (Molecular Adsorbent Recirculating System, molecular adsorbent recirculating system (MARS)) [8]
The MARS system has been commercially available since 1999 and its efficacy has been investigated in acute liver failure (ALF) and acute-on-chronic liver failure (ACLF), showing potential benefits in selected populations such as patients with severe hepatic encephalopathy [9], hepato-renal syndrome [10] and advanced liver failure with a MELD score more than 30 [11]

Summary

Introduction

The extent of liver resection and pre-existing liver disease, represent main determinants of the risk of postoperative complications [1,2,3]. Only few single centre experiences on the use of MARS as a rescue treatment option for PHLF have been reported [13,14,15,16,17] These reports contain heterogeneous groups of patients and applied a variety of different treatment protocols. The outcome is poor with few, if any, surviving patients Still, this is an ongoing problem and with the application of current treatment paradigms clinicians are not infrequently confronted with a rapidly progressive PHLF patient. This is an ongoing problem and with the application of current treatment paradigms clinicians are not infrequently confronted with a rapidly progressive PHLF patient The objective of this hypothesis-generating study is to present experience with MARS treatment in the setting of PHLF from two liver centers based on a retrospective analysis of treated patients, presented in the context of a review of the recent published literature

Objectives

Methods

Results

Conclusion