Abstract
Despite the many advancements in liver transplantation (LT), mortality in patients with hepatic failure remains high, and to date, many patients die while awaiting LT. The molecular adsorbent recirculating system (MARS®) is an extracorporeal liver support system intended to provide short-term metabolic detoxification, often as a vital bridge to LT. We report the case of a 41-year-old non-Hispanic White male who developed worsening multi-factorial encephalopathy in the setting of decompensated alcoholic cirrhosis. He continued to deteriorate despite supportive medical therapy, and extensive investigation for alternative causes of encephalopathy aside from hepatic was unrevealing; as a result, there was concern that his encephalopathy was due to irreversible causes from which he may not recover appropriately following LT. We herein: i) describe the implementation of MARS as a diagnostic intervention for encephalopathy of uncertain etiology in a patient with end stage liver disease who, on the basis of prompt psychomotor improvement, underwent LT 19 days post-MARS implementation with an excellent clinical outcome and thus ii) propose the use of extracorporeal liver support not only as a short-term bridge but also as a diagnostic (and potentially therapeutic) measure in cases of cryptogenic encephalopathy, particularly in the setting of advanced liver disease.
Highlights
Despite the many advancements in the field of liver transplantation (LT), mortality in patients who develop hepatic failure remains high, and many patients die while awaiting LT, in large part due to organ scarcity
We present the case of a 41-year-old non-Hispanic White male who developed worsening encephalopathy in the setting of known decompensated alcoholic cirrhosis
MARS has continued to establish a role as an effective short-term therapy in patients with end stage liver disease, including hepatic encephalopathy
Summary
Despite the many advancements in the field of liver transplantation (LT), mortality in patients who develop hepatic failure remains high, and many patients die while awaiting LT, in large part due to organ scarcity. We present the case of a 41-year-old non-Hispanic White male who developed worsening encephalopathy in the setting of known decompensated alcoholic cirrhosis. He continued to deteriorate despite aggressive supportive medical therapy, prompting extensive investigation for alternative causes of encephalopathy. A 41-year-old, non-Hispanic White male with a past medical history significant for decompensated alcoholic cirrhosis (model end stage liver disease (MELD) score of 30) presented to our institution for inpatient LT evaluation. Despite alcohol cessation eight months prior, his clinical condition continued to worsen, and he was requiring frequent hospitalizations for hepatic encephalopathy and acute on chronic kidney injury His outpatient medications included lactulose, titrated to three bowel movements per day, rifaximin, zinc sulfate, furosemide, and spironolactone. At his two-year follow-up, he continues to do well
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