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

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.