• Christophe Camus, Sylvain Lavoué, Arnaud Gacouin, Le Tulzo Yves Y, Richard Lorho, Karim Boudjéma, Christian Jacquelinet, and Rémi Thomas.
• Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, rue Henri Le Guilloux, CHRU, 2, 35033, Rennes Cedex, France. christophe.camus@chu-rennes.fr
• Intensive Care Med. 2006 Nov 1; 32 (11): 1817-25.

ObjectiveTo assess the usefulness of dialysis with the molecular adsorbent recirculating system (MARS) in patients with acute liver failure who fulfil criteria for liver transplantation.DesignObservational cohort study.SettingICU at a liver transplantation centre.PatientsTwenty-two patients (23 episodes) received MARS dialysis. They were either listed for LT (n=14), delayed (n=1), or not listed (contra-indication, n=7).InterventionsA total of 56 MARS treatments (median per patient 2; mean duration 7.6+/-2.6h) were performed on haemodialysis.Measurements And ResultsClinical and biological variables were assessed before and 24[Symbol: see text]h after MARS therapy. The rate of recovery of liver function without transplantation was compared with an expected rate and survival was analysed. Following MARS dialysis, we observed an improvement in the grade of hepatic encephalopathy (P=0.02) and the Glasgow coma score (P=0.02), a decrease in conjugated bilirubin (P=0.05) and INR (P=0.006), and an increase in prothrombin index (P=0.005). Overall, liver function improved in seven patients (32%): four listed patients in whom transplantation could be avoided and three patients among those not listed due to contra-indications. The transplant-free recovery rate in listed patients was 29% (vs. expected 9%, P=0.036). Listed patients (n=14) had a higher 30-day survival rate [86% (12/14) vs 38% (3/8), P=0.05] and a higher long-term survival rate (P=0.02).ConclusionsA statistically significant improvement of liver function was observed after MARS therapy. Transplant-free recovery was more frequent than expected. The apparent benefit of MARS dialysis to treat acute liver failure needs to be confirmed by a controlled study.

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