The role of MARS in patients suffering from hypoxic liver failure secondary to cardiogenic shock

Abstract

For patients with hepatorenal syndrome improvement of survival and of multiple organ functions was proven by the use of MARS (Molecular Adsorbent Recirculating System). MARS is a modified dialysis using an albumin-containing dialysate, that is recirculated and on-line perfused through charcoal and anion exchanger columns. It allows the selective removal of albumin-bound substances. Despite advances in medical therapy and technology, the prognosis of patients with cardiogenic shock remains poor. Mortality rates as high as 80%, often caused by persistent multiple organ failure are unacceptable. Therefore we conducted a prospective, randomized, and controlled study with patients suffering from hypoxic liver failure following cardiogenic shock after cardiac surgery. Main aim was to prove that MARS improves survival. We report a interim analysis of the 17 patients, who were included between 8/00 and 8/01 in our study. Eight patients formed the MARS group (MG) and 9 were in the non-MARS group (NMG). All patients had bilirubin levels >8 mg/ mL. The risk profile of both groups was almost identical. The MG received MARS for 3 consecutive days — if bilirubin was still >6 mg/ dl afterwards MARS was continued. The NMG received conventional therapy. Results: There were 6 survivors in the MG, compared to 1 survivor in the NMG ( P=0.015). Moreover Bilirubin levels declined faster to lower levels in the MG. Conclusion: Despite the limited number of patients included in this interim analysis, MARS can be recommended for patients with acute, hypoxic liver failure as it might significantly improve survival.