Combined Modality Therapy ; Hemodiafiltration ; methods ; Humans ; Liver Failure, Acute ; therapy ; Liver, Artificial ; Multiple Organ Failure ; prevention & control ; Plasma Exchange ; methods ; Renal Dialysis ; methods ; Sorption Detoxification ; methods

BACKGROUNDA liver support therapy, named molecular adsorbents recirculating system (MARS), has been used for more than 700 liver failure patients in China. We made here a summary to evaluate the effects of MARS treatment in different applications with emphasis on hepatitis B virus (HBV) based liver failure.

METHODSThis report analyzed data of 252 patients (mean age (44.9+/- 12.7) years) in three groups: acute severe hepatitis (ASH), subacute severe hepatitis (SSH) and chronic severe hepatitis (CSH). The largest group was CSH (156 patients, 61.9%), and 188 patients (74.6%, 188/252) were infected with HBV.

RESULTSMARS treatments were associated with significant reduction of albumin bound toxins and water-soluble toxins. Most of the patients showed a positive response with a significant improvement of multiple organ function substantiated by a significant increase in prothrombin time activity (PTA) and median arterial pressure (MAP). There was a decrease in hepatic encephalopathy (HE) grade and Child-Turcotte-Pugh (CTP) scale. Thirty-nine of 188 HBV patients (20.7%) dropped out of the commendatory consecutive therapy ending with lower survival of 43.6% while the rest of the 149 patients had a survival rate of 62.4%. Survival within the ASH and SSH groups were 81.2% and 75.0%, respectively. In the CSH group, end stage patients were predominant (65/151, 43%), whereas the early and middle stage patients had a better prognosis: early stage survival, including orthotopic liver transplantation (OLT) survival of 91.7%, middle stage survival of 75%, end stage survival of 33.8%.

CONCLUSIONSMARS continues to be the most favorable extracorporeal treatment for liver support therapy in China for a wide range of conditions, including the majority of hepatitis B related liver failure conditions. The appropriate application of MARS for the right indications and stage of hepatic failure, as well as the fulfillment of prescribed treatments, will lead to the optimal therapeutic result.

Humans ; Liver Failure ; mortality ; therapy ; Renal Dialysis ; Sorption Detoxification ; adverse effects ; methods

Adolescent ; Adult ; Female ; Hepatic Encephalopathy ; therapy ; Humans ; Liver, Artificial ; Male ; Middle Aged ; Renal Dialysis ; Sorption Detoxification

Humans ; Liver Failure ; therapy ; Liver, Artificial ; adverse effects ; Renal Dialysis ; adverse effects ; Sorption Detoxification ; adverse effects

Hemoperfusion ; Hepatic Encephalopathy ; therapy ; Hepatitis, Viral, Human ; therapy ; Humans ; Liver, Artificial ; Plasma Exchange ; Sorption Detoxification

OBJECTIVETo evaluate the effect of treatments with the molecular adsorbents recirculating system (MARS) on liver failure patients of severe hepatitis B, in order to seek a safe and effective therapeutic method which contribute to the improved survival rate for severe hepatitis patients.

METHODS52 liver failure patients of severe hepatitis B were performed intermittent MARS therapy for 6 to 8 hours per time in addition to standard medical treatment. Parameters in blood chemical data were collected before and after every treatment and analyzed in comparison with those parameters from controlled groups by means of plasma exchange and standard medical therapy.

RESULTSMARS therapy achieved a remarkable improvement in clinical symptoms and physic signs, accompanied with a significant decrease in serum bilirubin, ammonia, urea nitrogen, fragrant amino acid, endotoxin, IL-6, and TNF-alpha levels (0.05); at the 72 hours bilirubin rebounding analysis. MARS treatments resulted in a significant decrease of bilirubin rebounding level in comparison with what PE did (0.01 ), though the bilirubin removal efficiency between two groups was not statistically significant. The overall survival rate of MARS therapy was 50% (26/52), which was better than that of standard medical therapy (40.5%, 17/42, P less than 0.05).

CONCLUSIONThe results indicated that MARS was a safe and promising technology in the field of liver support therapy. It might be associated with considerable improved survival rate for liver failure patients.

Adult ; Female ; Hepatitis B ; complications ; Humans ; Liver Failure ; blood ; mortality ; therapy ; Male ; Renal Dialysis ; Sorption Detoxification ; Survival Rate

No abstract available.
Peritoneal Dialysis, Continuous Ambulatory* ; Pharmacokinetics* ; Renal Dialysis*

Combined Modality Therapy ; Hepatitis, Viral, Human ; complications ; therapy ; Humans ; Liver Failure ; etiology ; therapy ; Liver Transplantation ; Liver, Artificial ; Renal Dialysis ; methods ; Retrospective Studies ; Severity of Illness Index ; Sorption Detoxification ; methods

Adolescent ; Adult ; Amanita ; Amanitins ; blood ; Child ; Child, Preschool ; Female ; Hemoperfusion ; Humans ; Liver Diseases ; etiology ; therapy ; Liver, Artificial ; Male ; Mushroom Poisoning ; complications ; therapy ; Plasma Exchange ; Sorption Detoxification

No abstract available.
Anemia* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis*