Molecular adsorbent recirculating system for acute and acute-on-chronic liver failure: A meta-analysis

Khuroo, Mohammed Sultan; Khuroo, Mehnaaz S.; Farahat, K.

doi:10.1002/lt.20139

Cited by 166 publications

(93 citation statements)

References 33 publications

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“…A metaanalysis of four randomized and two selected non-randomized studies involving the administration of MARS to ACLF patients failed to demonstrate any effect on mortality [13,14,[25][26][27][28][29]. An in-depth analysis of non-randomized studies, however, corroborated a significant decrease in mortality in the MARS group compared to the group of patients who received standard treatment [25].…”

Section: Discussionmentioning

confidence: 96%

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

Piechota¹,

Piechota

Misztal

et al. 2019

aoms

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A b s t r a c t Introduction:The mortality rate in patients with severe liver dysfunction with no option of transplantation is unacceptably high. The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support (ECLS) techniques in this group of patients. Material and methods: Data from hospital admissions of 101 patients with severe liver dysfunction who were admitted to the department of anaesthesiology and intensive therapy between 2006 and 2015 were retrospectively analysed. The study group was divided into two subgroups. Standard medical therapy (SMT) was a subgroup of patients receiving standard medical therapy, and SMT + ECLS was a subgroup containing patients receiving standard medical therapy complemented by at least one extracorporeal liver support procedure. Extracorporeal liver support techniques used included fractionated plasma separation and adsorption and/or single pass albumin dialysis. Results: Significantly lower intensive care unit (ICU) mortality and 30-day mortality rates were found in the SMT + ECLS subgroup. No difference in 3-month mortality was identified between the two groups. In a multivariate model, independent risk factors for ICU mortality proved to be the SOFA score and prothrombin time. The highest discriminatory power for ICU mortality was demonstrated for the SOFA score, followed by APACHE II, SAPS II, MELD UNOS and GCS scores. For 30-day mortality, however, the best discriminatory power was shown for the SAPS II score, followed by SOFA, APACHE II, MELD UNOS and GCS scores. Conclusions: Further studies are needed to assess the contribution of non-biological extracorporeal liver support procedures to a decrease in mortality rates in the population of patients with severe liver dysfunction.

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Section: Discussionmentioning

confidence: 96%

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

Piechota¹,

Piechota

Misztal

et al. 2019

aoms

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“…Finally, the specificity of the effects of MARS should be viewed with caution: A systematic review of 6 randomized controlled trials of different types of artificial devices for acute-on-chronic liver failure (including MARS) indicate an overall beneficial effect on survival. 24 However, another more recent meta-analysis did not suggest improved survival with MARS in patients with acute-on-chronic failure. 25 Therefore, the benefit of MARS in improving survival needs to be addressed further.…”

Section: Discussionmentioning

confidence: 98%

“…During the follow-up period, there were 7 patients with gastrointestinal bleeding (days 6,8,8,19,24,31, and 92) in the ECAD versus only 1 patient in the SMT group (day 80). None of these bleeding events were deemed related to ECAD by the DSMB.…”

Section: Tolerability and Safety Of Ecadmentioning

confidence: 99%

Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis

et al. 2007

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Extracorporeal albumin dialysis (ECAD) may improve severe hepatic encephalopathy (HE) in patients with advanced cirrhosis via the removal of protein or non-protein-bound toxins. A prospective, randomized, controlled, multicenter trial of the efficacy, safety, and tolerability of ECAD using molecular adsorbent recirculating system (MARS) was conducted in such patients. Patients were randomized to ECAD and standard medical therapy (SMT) or SMT alone. ECAD was provided daily for 6 hours for 5 days or until the patient had a 2-grade improvement in HE. HE grades (West Haven criteria) were evaluated every 12 hours using a scoring algorithm. The primary endpoint was the difference in improvement proportion of HE between the 2 groups. A total of 70 subjects [median age, 53; 56% male; 56% HE grade 3; 44% HE grade 4; median model for end-stage liver disease (MELD) 32 (11-50) and CPT 13 (10-15)] were enrolled in 8 tertiary centers. Patients were randomized to ECAD ؉ SMT (n ‫؍‬ 39) or SMT alone (n ‫؍‬ 31). Groups were matched in demographics and clinical variables. The improvement proportion of HE was higher in ECAD (mean, 34%; median, 30%) versus the SMT group (mean, 18.9%; median, 0%) (P ‫؍‬ 0.044) and was reached faster and more frequently than in the SMT group (P ‫؍‬ 0.045). H epatic encephalopathy (HE) is a complex neuropsychiatric syndrome commonly seen in patients with advanced liver disease. HE arises from the effects of circulating toxins on cerebral functions. Putative toxic molecules accumulate in patients with liver decompensation because of increased production, portal-systemic shunting, or lack of hepatic detoxification. 1 Patients with advanced cirrhosis and a superimposed acute liver injury often decompensate and present with manifestations of hepatic failure, including worsening HE and coma. 2 .Current therapy for HE includes the use of nonabsorbable disaccharides or poorly absorbable antibiotics, as proposed more than 3 decades ago. 3 However, standard therapy is less effective in patients with severe degrees of liver failure. 4,5 Under these circumstances, the concept of supporting the failing liver for a time while correcting the precipitating event might help patients recover from HE or be stabilized until they receive a liver transplant. 6 Extracorporeal albumin dialysis (ECAD) using the molecular adsorbent recirculating system (MARS) is a new method of hemodiafiltration whereby blood is dialyzed against an albumin-containing solution across a high-flux membrane. 7 The technique allows combined removal of albumin-bound and water-soluble toxins. [8][9][10][11][12] In uncontrolled trials of ECAD using the MARS device, patients had a reduction in ammonia levels, clear-

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“…1,2 MARS therapy consists of filtering blood through a specialized albumin-containing dialysate to remove protein-bound toxins. Blood is filtered in-line through a charcoal column and an anion exchanger column before return.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation with multiple-organ failure: Can molecular adsorbent recirculating system therapy improve survival?

Sparks

Cavarocchi

Hirose

2017

The Journal of Heart and Lung Transplantation

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Molecular adsorbent recirculating system for acute and acute-on-chronic liver failure: A meta-analysis

Cited by 166 publications

References 33 publications

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

An evaluation of the usefulness of extracorporeal liver support techniques in patients with severe liver dysfunction

Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis

Extracorporeal membrane oxygenation with multiple-organ failure: Can molecular adsorbent recirculating system therapy improve survival?

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