Usefulness and safety of extracorporeal liver support therapy using MARSR for patients with liver failure: a preliminary report

BACKGROUND/AIMS: The molecular adsorbent recirculating system (MARSR) is a form of artificial extracorporeal liver support and can be used for a bridge to spontaneous recovery of hepatic function or liver transplantation in patients with liver failure. This study evaluated the usefulness of MARSR in patients with liver failure. METHODS: Between January 2004 and July 2007, 30 patients (21 males and 7 females; age 48.9+/-12.9 years) with acute or acute-on-chronic liver failure were managed using MARSR. We assessed laboratory data, the grade of hepatic encephalopathy, Child-Turcotte-Pugh class, and Model for End-Stage Liver Disease (MELD) score. RESULTS: The number of patients with acute liver failure and acute-on-chronic liver failure was 16 and 14, respectively. The mean cycle of MARSR in patients with liver failure was 2.2 sessions. After MARSR had been performed, serum total bilirubin, alanine aminotransferase (ALT), BUN, creatinine, ammonia level, daily urine output, and MELD score were improved (p<0.05). In contrast, MARSR failed to improve Child-Turcotte-Pugh score and the grade of hepatic encephalopathy. Liver transplantation was performed in 8 patients. Among them, 5 (62.5%) patients survived and 3 (37.5%) patients died. Twenty two patients underwent MARSR without liver transplantation and 4 (18.2%) of them survived. CONCLUSIONS: In patients with liver failure, MARSR improved the laboratory data and hepatic and renal function associated clinical characteristics. However, MARSR without liver transplantation did not improve survival. MARSR may be useful as a bridge therapy to liver transplantation in patients with liver failure.