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Vol. 27. Issue S3.
Abstracts from XVII Mexican Congress of Hepatology
(December 2022)
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Vol. 27. Issue S3.
Abstracts from XVII Mexican Congress of Hepatology
(December 2022)
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Acute liver failure and experience with therapy using the molecular absorbent recirculation system (MARS)
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FI García-Juárez, I García-Espinosa, VM Páez-Zayas, A Sánchez-Cedillo, A Pérez-Calatayud, F Higuera-de-la-Tijera, JL Perez-Hernandez
Gastroenterology and Hepatology. General Hospital of Mexico “Dr. Eduardo Liceaga.” Mexico City, Mexico
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Vol. 27. Issue S3

Abstracts from XVII Mexican Congress of Hepatology

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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.

Full Text

Table 1 Laboratory values before and after the use of MARS therapy.

  Before  After 
Hemoglobin (g/L)  17.90  13 
Leukocytes (cell/10310.4  6.10 
Platelets (cell/103213  207 
Glucose (mg/dL)  86  71 
Creatinine (mg/dL)  3.2  1.93 
Total bilirrubin (mg/dL)  16.1  10 
Direct bilirrubin (mg/dL)  14  5.8 
ALT (U/L)  2409  824 
AST (U/L)  772  257 
ALP (U/L)  110.5  77 
GGT (U/L)  501  136 
ALB (g/dL)  3.90  2.8 
INR  3.4  1.1 
PT (Sec)  36.9  21.8 
aPPT (Sec)  45  31 
  Hepatitis A virus IgM   

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