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Molecular adsorbent recirculating system (MARS) in acute liver injury and graft dysfunction: Results from a case-control study.

Abstract The primary therapeutic goals in the treatment of liver injury are to support liver regeneration or bridge the gap to liver transplantation (LT). Molecular adsorbent recirculating system (MARS) therapy has shown beneficial effects for specific symptoms of liver failure; however, general survival advantages have not yet been demonstrated.
PMID
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Journal Title plos one
Publication Year Start




PMID- 28403210
OWN - NLM
STAT- MEDLINE
DA  - 20170413
DCOM- 20170421
LR  - 20170421
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 4
DP  - 2017
TI  - Molecular adsorbent recirculating system (MARS) in acute liver injury and graft
      dysfunction: Results from a case-control study.
PG  - e0175529
LID - 10.1371/journal.pone.0175529 [doi]
AB  - BACKGROUND: The primary therapeutic goals in the treatment of liver injury are to
      support liver regeneration or bridge the gap to liver transplantation (LT).
      Molecular adsorbent recirculating system (MARS) therapy has shown beneficial
      effects for specific symptoms of liver failure; however, general survival
      advantages have not yet been demonstrated. AIM: We studied the effects of MARS
      therapy compared to standard medical treatment (SMT) in two patient cohorts: in
      patients with an acute liver injury and in those with graft dysfunction (GD).
      METHODS: We report on our experience over a 6.5-year period with 73 patients
      treated with SMT or with SMT and MARS (MARS group). In total, 53 patients
      suffered from acute liver injury in their native liver without a preexisting
      liver disease (SMT: n = 31, MARS: n = 22), and 20 patients showed a severe GD
      after LT (SMT: n = 10, MARS: n = 10). RESULTS: The entire cohort was
      predominantly characterized by hemodynamically and respiratorily stable patients 
      with a low hepatic encephalopathy (HE) grade and a model of end-stage liver
      disease (MELD) score of 20.57 (MARS) or 22.51 (SMT, p = 0.555). Within the MARS
      group, the median number of extracorporeal therapy sessions was four (range = 3-5
      sessions). Independent of the underlying etiology, MARS improved the patients'
      bilirubin values in the short term compared to SMT alone. In patients with acute 
      liver injury, this response was sustained even after the end of MARS therapy. By 
      contrast, the majority of patients with GD and an initial response to MARS
      therapy experienced worsened hyperbilirubinemia. No differences in 28-day
      mortality were observed with respect to acute liver injury (MARS 5.3% (95% CI:
      0-15.3); SMT 3.3% (95% CI: 0-9.8), p = 0.754) or GD (MARS 20.0% (95% CI: 0-44.7),
      SMT 11.1% (95% CI: 0-31.7), p = 0.478). CONCLUSIONS: Although it did not improve 
      28-day mortality, MARS therapy improved the short-term response in patients with 
      acute liver injury as well as in those with GD. In cases of acute hepatic injury,
      the use of MARS therapy resulted in the sustained stabilization of liver function
      and improved liver regeneration. A short-term response to MARS may predict the
      future course of the disease.
FAU - Gerth, Hans U
AU  - Gerth HU
AD  - Department of Medicine D, Division of General Internal Medicine, Nephrology, and 
      Rheumatology, University Hospital Muenster, Muenster, Germany.
FAU - Pohlen, Michele
AU  - Pohlen M
AUID- ORCID: http://orcid.org/0000-0002-0333-0297
AD  - Department of Medicine A, Hematology and Oncology, University Hospital Muenster, 
      Muenster, Germany.
FAU - Tholking, Gerold
AU  - Tholking G
AD  - Department of Medicine D, Division of General Internal Medicine, Nephrology, and 
      Rheumatology, University Hospital Muenster, Muenster, Germany.
FAU - Pavenstadt, Hermann
AU  - Pavenstadt H
AD  - Department of Medicine D, Division of General Internal Medicine, Nephrology, and 
      Rheumatology, University Hospital Muenster, Muenster, Germany.
FAU - Brand, Marcus
AU  - Brand M
AD  - Department of Medicine D, Division of General Internal Medicine, Nephrology, and 
      Rheumatology, University Hospital Muenster, Muenster, Germany.
FAU - Wilms, Christian
AU  - Wilms C
AD  - Department of Transplant Medicine, University Hospital Muenster, Muenster,
      Germany.
FAU - Husing-Kabar, Anna
AU  - Husing-Kabar A
AD  - Department of Transplant Medicine, University Hospital Muenster, Muenster,
      Germany.
FAU - Gorlich, Dennis
AU  - Gorlich D
AD  - Institute of Biostatistics and Clinical Research, University Muenster, Muenster, 
      Germany.
FAU - Kabar, Iyad
AU  - Kabar I
AD  - Department of Transplant Medicine, University Hospital Muenster, Muenster,
      Germany.
FAU - Schmidt, Hartmut H J
AU  - Schmidt HH
AD  - Department of Transplant Medicine, University Hospital Muenster, Muenster,
      Germany.
LA  - eng
PT  - Journal Article
DEP - 20170412
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - RFM9X3LJ49 (Bilirubin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Bilirubin/blood
MH  - Case-Control Studies
MH  - Chemical and Drug Induced Liver Injury/blood/*therapy
MH  - Female
MH  - Graft Rejection/blood/*therapy
MH  - Humans
MH  - Liver/pathology
MH  - Liver Regeneration
MH  - Liver Transplantation
MH  - Male
MH  - Middle Aged
MH  - Sorption Detoxification
MH  - Treatment Outcome
EDAT- 2017/04/14 06:00
MHDA- 2017/04/22 06:00
CRDT- 2017/04/14 06:00
PHST- 2017/02/08 [received]
PHST- 2017/03/27 [accepted]
AID - 10.1371/journal.pone.0175529 [doi]
AID - PONE-D-17-05208 [pii]
PST - epublish
SO  - PLoS One. 2017 Apr 12;12(4):e0175529. doi: 10.1371/journal.pone.0175529.
      eCollection 2017.

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