MARS therapy in critically ill patients with advanced malignancy: a clinical and technical report

Tan, Han Khim; Lim, JeongAe; Tan, Chong Kiat; Ng, Han Seong; Chow, Pierce K.H.; Lui, Hock Foong; Wong, Gordon C K; Tan, Paul; Raghuram, Jyothi; Ng, He ng Joo; Choong, Lina Hui Lin; Wong, Kok‐Seng; Woo, Keng Thye

doi:10.1034/j.1478-3231.23.s.3.3.x

Cited by 9 publications

(2 citation statements)

References 29 publications

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“…Non-specific PHLF studies. In the 17 non-specific PHLF studies, [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] the treatment and outcomes of PHLF patients were pooled with other causes of liver failure making it impossible to extract specific information about the treatment of PHLF patients. In general, all studies reported a significant decrease of plasma bilirubin, creatinine and clinical improvement of pruritus and encephalopathy after MARS treatment.…”

Section: Mars In Phlfmentioning

confidence: 99%

Systematic review of MARS treatment in post-hepatectomy liver failure

Sparrelid

Gilg

Gulik

2020

HPB

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Background: Post-hepatectomy liver failure (PHLF) remains a serious complication after major liver resection with severe 90-day mortality. Molecular adsorbent recirculating system (MARS) is a potential treatment option in PHLF. This systematic review sought to analyze the experiences and results of MARS in PHLF.Methods: Following the PRISMA guidelines, a systematic literature review using PubMed and Embase was performed. Non-randomized trials were assessed by the MINORS criteria.Results: 2884 records were screened and 22 studies were extracted (no RCT). They contained 809 patients including 82 patients with PHLF. Five studies (n = 34) specifically investigated the role of MARS in patients with PHLF. In these patients, overall 90-day survival was 47%. Patients with primary PHLF had significantly better 90-day survival compared to patients with secondary PHLF (60% vs 14%, p = 0.03) and treatment was started earlier (median POD 6 (range 2-21) vs median POD 30 (range 15-39); p < 0.001). Number of treatments differed non-significantly in these groups. Safety and feasibility of early MARS treatment following hepatectomy was demonstrated in one prospective study. No major adverse events have been reported. Conclusion:Early MARS treatment is safe and feasible in patients with PHLF. Currently, MARS cannot be recommended as standard of care in these patients. Further prospective studies are warranted.

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Section: Mars In Phlfmentioning

confidence: 99%

Systematic review of MARS treatment in post-hepatectomy liver failure

Sparrelid

Gilg

Gulik

2020

HPB

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“…Data from the limited pediatric studies suggest that MARS therapy is not harmful to pediatric patients. There is only 1 case report of ELS use in a patient with severe VOD who did not survive, and thus it is difficult to make any evidencebased recommendations [115]. Moreover, this technology might not be available in most centers.…”

Section: Q10: What Are the Indications For Extracorporeal Liver Suppomentioning

confidence: 99%

Consensus Report by the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplantation Consortium Joint Working Committees on Supportive Care Guidelines for Management of Veno-Occlusive Disease in Children and Adolescents, Part 3: Focus on Cardiorespiratory Dysfunction, Infections, Liver Dysfunction, and Delirium

Ovchinsky

Frazier

Auletta

et al. 2018

Biology of Blood and Marrow Transplantation

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Some patients with veno-occlusive disease (VOD) have multiorgan dysfunction, and multiple teams are involved in their daily care in the pediatric intensive care unit. Cardiorespiratory dysfunction is critical in these patients, requiring immediate action. The decision of whether to use a noninvasive or an invasive ventilation strategy may be difficult in the setting of mucositis or other comorbidities in patients with VOD. Similarly, monitoring of organ functions may be very challenging in these patients, who may have fulminant hepatic failure with or without hepatic encephalopathy complicated by delirium and/or infections. In this final guideline of our series on supportive care in patients with VOD, we address some of these questions and provide evidence-based recommendations on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplantation Consortium Joint Working Committees.

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A molecular adsorbent recycling system in treating posthepatectomy acute hepatic failure patients with hepatocellular carcinoma: a bridge to liver transplantation

Wang

Liu

Zheng

et al. 2006

Chin. J. Clin. Oncol.

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OBJECTIVE To evaluate the effect and safety of a Molecular AdsorbentRecycling System (MARS) in treating posthepatoectomy hepatic failure (AHF) patients surgically treated for primary hepatocellular carcinoma (HCC).METHODS 12 AHF patients induced by resection of HCC were treated with MARS before orthotopic liver transplantation (OLT). Their vital signs, urine volume, APACHEIII and Glasgow scores were monitored. Routine laboratory blood tests, measurements of coagulatory function, liver and kidney function, serum ammonia, lactic acid and blood gas were conducted before and after treatment with MARS. All of the patients were followed up for a period of 6 months after OLT for prognosis and complication assessment. RESULTSEach patient was treated with MARS for 2~5 times (average of 3.6) with a length of 8N24 h each time. Their mean arterial blood pressure and urine volume were improved, APACHE III and Glasgow scores were better. Liver function was improved with the following alterations before and after treatment with MARS: serum ammonia (127.1_+21.4 umol/L vs. 77.4_+19.7 umol/L, P<0.05), lactic acid (6.53_+0.45 mmol/L vs. 3.75_+ 0.40 mmol/L, P<0.05) and total bilirubin (452.3_+15&7 umol/L vs. 230.9+ 115.2 umol/L, P<0.05). However, there was no significant change in platelet count (44.25-+3.60x109/L vs. 43.19_+8.26x109/L, P>0.05) on international normalized ratio (INR) (2.74-+0.50 vs. 2.82_+0.60, P>0.05), which showed the safety of MARS. For all patients no serious adverse effects occurred during the treatment with MARS.CONCLUSION MARS is effective and safe for treatment of AHF patients with HCC, especially as a bridge to ©LT when a donor organ is not available.

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MARS therapy in critically ill patients with advanced malignancy: a clinical and technical report

Cited by 9 publications

References 29 publications

Systematic review of MARS treatment in post-hepatectomy liver failure

Systematic review of MARS treatment in post-hepatectomy liver failure

A molecular adsorbent recycling system in treating posthepatectomy acute hepatic failure patients with hepatocellular carcinoma: a bridge to liver transplantation

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