Introduction: Molecular adsorbent recirculating system (MARS) is an artificial albumin dialysis-based liver support system that has been developed for patients with liver failure and has been FDA-approved in the treatment acute liver failure due to drug overdose and poisonings, as well as hepatic encephalopathy (HE) due to decompensation of chronic liver disease. This case series presents 2 subsets of liver failure patients: 1 patient with acute liver failure (ALF) in the setting of autoimmune hepatitis (AIH), and a second patient with acute on chronic liver failure (ACLF) in the setting of ischemic hepatitis on a background of alcoholic cirrhosis. The uniqueness of our case series is that MARS therapy was utilized to stabilize a anhepatic state in both ALF and ACLF for a duration of 96 hours, and subsequently bridge the patients to successful liver transplantation. Our first patient was a 56-year-old female who was transferred to our university hospital for acute liver injury. The patient was started on MARS therapy in the setting of grade 4 hepatic encephalopathy, severe coagulopathy (INR>9), and a profound metabolic acidosis. Cardiopulmonary, neurologic, and metabolic stability was maintained on MARS therapy for 96 hours, and the patient subsequently underwent successful liver transplantation. Of note, the liver explant demonstrated greater than 90% hepatic necrosis. Our second patient was a 67-year-old male with alcoholic cirrhosis, who developed severe ACLF in the setting of profound superimposed ischemic hepatitis due to anaphylactic shock. Clinical parameters were consistent with severe hepatic insufficiency, as evidenced by a profound coagulopathy (INR>10) and grade 4 hepatic encephalopathy. Timely administration of MARS therapy was successful in clinical stabilization of the patient, despite minimal hepatic function. Following approximately 96 hours of MARS therapy, the patient was successfully bridged to liver transplantation. Explant pathology of the native liver demonstrated extensive hepatic necrosis on a background of cirrhosis. These 2 cases demonstrate the efficacy of MARS therapy in stabilizing the clinical status of patients in both ALF and ACLF in the setting of severe hepatic insufficiency. In particular, both these patients were stabilized for 4 days in a virtually anhepatic state while they awaited liver transplantation. Severe hepatic insufficiency is typically characterized by severe multi-organ system failure that is prohibitive for liver transplantation. This case series demonstrates the ability of MARS therapy to prevent multi-organ system failure in the setting of a prolonged anhepatic state, and the opportunity to utilize this therapy as a bridge to liver transplantation. Disclosure - Dr. Ram Subramanian is a consultant for Gambro.