Acute liver failure and experience with therapy using the molecular absorbent recirculation system (MARS)

Abstract

Introduction and Objective: Acute liver failure (ALF) is a cause of urgent liver transplantation (LT). The molecular absorbent recirculation system (MARS) is an extracorporeal liver replacement device, considered bridging therapy for LT. Case report: 24-year-old man with no relevant history was admitted due to asthenia, adynamic, hyporexia, jaundice, oral intolerance and transaminasemia. His laboratory studies are shown in Table 1 and include positivity for IgM hepatitis A (HAV). Other causes are excluded. Development of ALF with two minor criteria (King's College), received N-acetylcysteine, without response, management with MARS/PRISMA is started, one session (initial dialysate 1300 mL, increasing to 1800 mL, maintaining a flow of 150 mL/L, and eight bottles of 25% albumin (400 mL)). His evolution towards neurological, hepatic, and renal improvement. Discharged for improvement. Discussion: MARS therapy is based on removing molecules, including medium-sized ones, especially those that are binding by albumin and, therefore, cannot be purified conventionally. The relative simplicity, the good tolerance and the results obtained so far make MARS the most promising alternative. There is some experience with the use of MARS in ALF due to HAV. Conclusion: MARS therapy is useful in the management of patients with ALF due to HAV; its use has shown positive results impacting patient survival and even, in some cases, avoids liver transplantation. The number of sessions will depend on the clinical response. Funding: The resources used in this study were from the hospital without any additional financing Declaration of interest: The authors declare no potential conflicts of interest.