Liver dialysis

Has anyone had experience regarding the MARS (Molecular Absorbant Recirculation System)therapy, to help with Pruritus symptoms prior to liver transplant. Thank you in advance.

I have never heard of this.

I hadn't heard of it either, but cursory research says....

Ann Acad Med Singapore. 2004 May;33(3):329-35.

Molecular adsorbent recirculating system (MARS).

Tan HK1.

Author information

Abstract

INTRODUCTION:

Molecular adsorbent recirculating system (MARS) for albumin liver dialysis has been used as a bridge to liver transplantation in patients with fulminant hepatic failure (FHF). This review examines the available data on its clinical use, its technical aspects and present gaps in knowledge.

METHODS:

Peer-reviewed journals and monographs on the subject were covered.

RESULTS:

FHF is associated with elevation in various substances including bilirubin, ammonia, lactate, free fatty acids and aromatic amino acids. Some of these toxic metabolites, such as ammonia and bilirubin, are believed to be central to the clinical manifestations of hepatic encephalopathy and acute renal failure. MARS ameliorates both biochemical and clinical manifestations of FHF by removing both water-soluble and protein-bound toxins. Among the benefits of MARS is the attenuation of severe cerebral oedema and raised intracranial pressure found in FHF, possibly through reduction in high concentrations of these toxins. Although MARS has been shown to be useful in FHF, its clinical efficacy in subfulminant hepatic failure and less severe forms of acute liver failure (ALF) remains uncertain. The current literature also suggests that it may be beneficial to treat cases of acute-on-chronic liver failure (AoCLF). Deranged systemic chemistries can be similarly ameliorated, but the impact of MARS on the natural history of AoCLF remains uncertain. The difficulty lies in being able to accurately quantify residual liver function and variability in the course of acute intercurrent events. The broader question is whether MARS can favourably change the natural history of ALF and FHF. For this, large multi-centre, randomised controlled trials are needed. Furthermore, it is also uncertain how hepatic excretory-assist devices, such as MARS, compare with bio-artificial liver-assist devices which have both synthetic and excretory hepatic functions in ALF treatment in intensive care unit patients. Nevertheless, MARS has proven to be a valuable homeostatic tool that may be useful in restoring the biochemical and clinical status quo in much the same way that continuous veno-venous haemofiltration and mechanical ventilation provide temporary artificial organ support while these organs are in distress. This is the evolving concept of multi-organ support therapy. Other major unresolved issues with MARS include the timing of initiation of albumin liver dialysis, the clinical and/or biochemical parameters to base this decision on, the intensity of MARS therapy (continuous versus intermittent) and the saturation capacity of the system for different metabolites in intermittent MARS.

CONCLUSIONS:

MARS is an effective and, thus far, safe homeostatic tool in treating FHF. More studies are needed to delineate its role as a homeostatic tool in less severe forms of ALF, including that which occurs in multi-organ failure and in AoCLF. Other studies need to focus on the optimal timing of initiation of and intensity of MARS albumin liver dialysis. The larger issue is to compare MARS with bio-assist liver devices in treating the whole spectrum of ALF.

Source: http://www.ncbi.nlm.nih.gov/pubmed/15175774

Queenb:

What hospital or medical facility offers this therapy?

Thanks!

Lilly

Hi Lilly, I am in Adelaide , South Australia, I received the MARS treatment at Flinders Medical Centre earlier this week, it seems to have shown to have a positive improvement, but time will tell.
I also was told that Kings Hospital in London also offer the treatment.

Hi Dennis, the MARS treatment went OK and gave me relief for the three days I was attached to the machine. Unfortunately the itching gradually returned within a week which was disappointing as I had hoped for some mid to long term improvement. My LFT revealed a marked improvement initially but soon returned to what they had been previously. So for me it didn’t help as much I had hoped, but it was worth a try. I am still awaiting a transplant which seems to be the only way forward. Hope this gives you a bit of information although it is not of a positive nature, hope you are well and thanks for your interest.