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Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation

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Abstract

Objective

To assess the usefulness of dialysis with the molecular adsorbent recirculating system (MARS) in patients with acute liver failure who fulfil criteria for liver transplantation.

Design

Observational cohort study.

Setting

ICU at a liver transplantation centre.

Patients

Twenty-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).

Interventions

A total of 56 MARS treatments (median per patient 2; mean duration 7.6 ± 2.6 h) were performed on haemodialysis.

Measurements and results

Clinical and biological variables were assessed before and 24 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).

Conclusions

A 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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Authors and Affiliations

  1. Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, rue Henri Le Guilloux, CHRU, 2, 35033, Rennes Cedex, France

    Christophe Camus, Sylvain Lavoué, Arnaud Gacouin, Yves Le Tulzo & Rémi Thomas

  2. Service des Maladies du Foie, Hôpital Pontchaillou, rue Henri Le Guilloux, CHRU, 2, 35033, Rennes Cedex, France

    Richard Lorho

  3. Département de Chirurgie Viscérale, Hôpital Pontchaillou, rue Henri Le Guilloux, CHRU, 2, 35033, Rennes Cedex, France

    Karim Boudjéma

  4. Agence de la Biomédecine, 1, avenue du Stade de France, 93210, Saint Denis, France

    Christian Jacquelinet

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  1. Christophe Camus
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  2. Sylvain Lavoué
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  3. Arnaud Gacouin
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  4. Yves Le Tulzo
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  6. Karim Boudjéma
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  7. Christian Jacquelinet
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  8. Rémi Thomas
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Correspondence to Christophe Camus.

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Camus, C., Lavoué, S., Gacouin, A. et al. Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation. Intensive Care Med 32, 1817–1825 (2006). https://doi.org/10.1007/s00134-006-0340-1

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  • DOI: https://doi.org/10.1007/s00134-006-0340-1

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