Advances in Extracorporeal Detoxification by MARS Dialysis in Patients with Liver Failure

Abstract

Although liver transplantation has become standard procedure for patients with liver failure, a number of issues in the management of these patients remains to be addressed. Alternative approaches have been tested, such as hepatocytes containing liver-support systems and filtration devices. However, the replacement of detoxification has been difficult, as the majority of toxins accumulating in liver failure is albumin-bound. Albumin dialysis (MARS system) is characterized by the specific removal of albumin-bound toxins through an innovative membrane transport. In particular, the albumin acts as a specific molecular adsorbent that is regenerated on line in a recycling system. Nowadays MARS represents the most frequently used liver support system. This treatment has been shown to remove albumin-bound molecules, such as bilirubin, bile acids, aromatic amino acids and copper. The removal of these toxins is clinically accompanied with an improvement of liver, cardiovascular and renal functions and hepatic encephalopathy. In several trials MARS was found to improve the clinical situation in patients with acute exacerbation of chronic liver failure and acute hepatic failure, but also in hepatorenal syndrome and primary graft non function or chronic rejection after liver transplantation. In summary, a critical analysis of the literature confirms that MARS device can be a safe therapeutic choice to achieve a better clinical outcome, and, sometimes, a survival advantage in patients with liver failure, even if a multi-center randomized trial is the only reliable way to enforce today's results. Further advances in the MARS components will definitively state whether albumin dialysis may represent the future in the field of artificial liver devices.

Survival predictors in patients treated with a molecular adsorbent recirculating system

“…In AOCLF, some randomized studies [5,6,8,22] and small case series of MARS-treated patients [25][26][27] have reported favorable effects. However, conflicting reports have also emerged [28] .…”

Effects of hemoperfusion adsorption and/or plasma exchange in treatment of severe viral hepatitis: A comparative study

“…In the past few years, because the advance of technique of activated charcoal filter and the particles of charcoal became smaller and their surface was processed, the chance of platelet destruction and erythrocyte destruction was He NH et al Three artificial liver support systems in treatment of severe viral hepatitismuch less when the blood flowed through activated charcoal filter, biocompatibility of activated charcoal improved [20] . Therefore, the therapy of hemoperfusion adsorption has again been applied to clinic to treat the liver failure patients [21][22][23] . That 24 patients had an improvement in clinical symptoms temporarily and in liver function indicates hemoperfusion adsorption therapy has a temporary supportive effect on liver failure caused by severe viral hepatitis.…”

Review article: a medicine based on cell transplantation – is there a future for treating liver diseases?

“…This is a mechanical device consisting of a continuous haemodiafiltration module based on an albumin‐impregnated permeable membrane that is able to remove both protein‐bound and water‐soluble toxins in the low and middle molecular weight range 6 . Most of the literature available at present is based on observational and noncontrolled trials, performed in more than 500 patients enrolled for a total of more than 2500 treatments in different clinical settings 7 . The removal of albumin‐bound molecules, such as bilirubin, bile acids, aromatic amino acids and copper, is accompanied by a rapid improvement in neurological status, haemodynamic stability and a better clinical outcome in patients with acute exacerbation of chronic liver failure and acute hepatic failure, but also in hepatorenal syndrome and primary graft non‐function or chronic rejection after liver transplantation 7 ,.…”

“…Whether there is room for an improvement of albumin‐dialysis performance, based on the concomitant use of isolated hepatocytes to simultaneously replace the missing synthetic and metabolic functions, remains an open question 7 …”