MARS™ Dialysis Machine

Bridging therapies in Liver Failure (including Liver Dialysis)

Patients with chronic liver failure are prone to hepatic decompensation from a variety of insults that include infection (especially spontaneous bacterial peritonitis), dehydration, variceal bleeding, excessive protein, and drugs or toxins. Standard medical management includes specific treatment for the specific insult (e.g. antibiotics for infection), and general supportive care which frequently requires ICU admission. Multiple organ failure frequently results from the decompensation, and ICU intervention provides support for the failing organs until recovery can occur. These interventions may include mechanical ventilation, inotropic support, renal replacement therapy, and nutritional support.

Of recent interest is the possibility of providing liver dialysis or liver assist devices that are targeted to improve liver function. The most widely currently used device is the MARS?liver dialysis machine, which is approved in Europe and currently undergoing FDA approval in USA. This device provides albumin dialysis, and is effective in reducing total bilirubin levels, ammonia levels, and improving hepatic encephalopathy in a substantial number of patients. It will also help patients with hepatorenal syndrome, and may possibly improve survival. In patients where liver transplantation may be an option, this may provide a useful bridge to bring the patient to transplantation successfully.

MARS liver dialysis is usually conducted in the ICU and requires the insertion of a double lumen catheter. The session usually last 6 to 10 hours depending on the patient's severity. Ocassionally it may even extend up to 24 hours using the Pris-MARS machine. ACLDT is experienced in providing the various forms of liver dialysis and have been using this for several years now.

Other devices are also being evaluated, and some of these provide putative hepatic synthetic support as well with the presence of hepatocytes. Most importantly, patients with liver failure should be managed in a specialized liver centre where liver transplantation is available along with a modern ICU.

References:
1	Outcome from Molecular Adsorbent Recyling System (MARS™ Liver Dialysis Following Drug-Induced Liver Failure. Liver International 2005: 25: 973-977.
2	Predicting the Amount of Conjugated Bilirubin Removal With Extracorporeal Albumin Dialysis MARS Utlizing the Pred-dialysis Conjugated Bilirubin:Albumin Ratio.  Liver Transplantation 2002;8:591-3.
3	Molecular Adsorbent Recirculating System for Acute and Acute-on-Chronic Liver Failure: A Meta-analysis. Liver Transpl 2004;10:1099-1106.
4	Liver failure: basis of benefit of therapy with the molecular adsorbents recirculating system. The International Journal of Biochemistry & Cell Biology 35 (2003) 1306-1311.
5	MARS liver dialysis in children with acute liver failure. Ann Acad Med Singapore. 2004 Sep;33(5 Suppl):S73-4.