Since its introduction in 1993, molecular adsorbent recirculating system (MARS) albumin dialysis has been a subject of research, with the hope of treating effectively patients with acute liver failure. The impact of MARS treatment on outcome as well as clinical and laboratory variables has been investigated widely in small non-randomized studies. However, larger studies with longer follow-up time are required to determine the true usefulness of MARS treatment in different liver failure etiologies.
An article to be published on June 28 2009 in the World Journal of Gastroenterology addressed this issue. The research led by Taru Kantola from Helsinki University Central Hospital, Finland discussed the prognostic factors for survival in patients with acute liver failure. The authors analysed the 1-year outcomes of 188 patients treated with MARS from 2001 to 2007, in an intensive care unit specializing in liver diseases.
They found that the etiology of liver failure was the most important predictor of survival. In acute liver failure (ALF) of toxic etiology (e.g., paracetamol), the grade of encephalopathy before MARS treatment was a significant prognostic factor. In ALF of unknown etiology, coagulation factor 5 and liver enzyme alanine aminotransferase levels were prognostic. According to the results, the MARS treatment of a cirrhotic patient with an acute-on-chronic liver failure is not meaningful in terms of prognosis if the patient is not eligible for transplantation.
Reference: Kantola T, Koivusalo AM, Parmanen S, Höckerstedt K, Isoniemi H. Survival predictors in patients treated with a molecular adsorbent recirculating system. World J Gastroenterol 2009; 15(24): 3015-3024. http://www.wjgnet.com/1007-9327/15/3015.asp
Correspondence to: Dr. Taru Kantola, Department of Anesthesiology and Intensive Care Medicine, Surgical Hospital of Helsinki, Helsinki University Central Hospital, PO Box 263, FIN-0029 HUCH, Helsinki, Finland. taru.kantola@hus.fi
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World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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World Journal of Gastroenterology