The molecular adsorbent recirculating system (MARS®): A therapy for the treatment of liver failure; review and case study

Abstract

The consequences of liver failure include hepatic encephalopathy, haemodynamic instability, cerebral oedema, renal failure, susceptibility to infection, coagulapathy and metabolic derangement. Liver transplantation is the only established treatment for patients who do not respond to medical management. However, the supply of organs for transplant is limited. Artificial liver support therapies are available to support patients in acute liver failure to allow time for liver recovery or to provide a bridge to transplantation. A young woman presenting with hyperacute liver failure resulting from paracetamol overdose was treated with an extracorpored liver support therapy using albumin as a dialysis medium, referred to and marketed as the Molecular Adsorbents Recirculating System (MARS®). MARS® setup, priming and initiation of therapy was undertaken by intensive care nursing staff and required new and advanced skills. On admission, her INR was 8.2, alanine transferase 10157 μ/L and paracetamol level 218 μmol/L. After three treatments for 19, 19 and 20 hours, respectively, using the MARS® technique, this patient began to recover. On day 6, all life support therapies were ceased and she made a full recovery and was discharged from hospital 17 days after hospital admission to Intensive Care. If MARS® gains increased acceptance, Australian critical care nurses are well placed to manage this new therapy using their past Continuous Renal Replacement Therapy (CRRT) experience as a foundation for learning a new extracorporeal organ support technique.