|
Molecular adsorbent recirculating system (Mars) in
patients with primary nonfunction and other causes of graft dysfunction
after liver transplantation in the era of extended criteria donor
organs.
Transplant Proc. 2009 Jan-Feb;41(1):253-8.
Gaspari R, Cavaliere F, Sollazzi L, Perilli V, Melchionda I, Agnes S, Gasbarrini A, Avolio AW.
Department of Anaesthesia and Intensive Care, Catholic University of Rome, Rome, Italy.
Liver
dysfunction is an important cause of morbidity and mortality after
orthotopic liver transplantation (OLT). The Molecular Adsorbent
Recirculating System (MARS) is an albumin-based dialysis system
designed to enhance the excretory function of a failing liver. MARS has
been successfully used in patients affected by advanced liver disease
and presenting with severe cholestasis. The aim of this study was to
evaluate the safety and clinical efficacy of MARS in patients with
liver dysfunction after OLT. Seven patients (primary nonfunction, 2
patients; graft dysfunction, 5 patients) fulfilled the inclusion
criteria of serum bilirubin level >15 mg/dL and least 1 of the
following clinical signs: hepatic encephalopathy (HE) > or = grade
II, hepatorenal syndrome (HRS), and intractable pruritus.
Graft and
patient survival rates at 6 months were 42.8% and 57.1%, respectively.
All patients tolerated MARS treatment, with no adverse event. In all
patients, a decrease in serum bilirubin (P < .05), bile acids (P
< .05), serum creatinine, and ammonia levels was observed after
treatment with MARS. A considerable improvement of HE, as well as renal
and synthetic liver functions, was observed in 4 of 5 patients with
graft dysfunction, but not among those with primary nonfunction. The
patients with intractable pruritus showed significant improvement of
this symptom after MARS therapy. Thus, MARS is a safe, therapeutic
option for the treatment of liver dysfunction after OLT. Further
studies are necessary to confirm whether this treatment is able to
improve both graft and patient survival.
|
