Ashrita Donepudi, MBBS
Dr
Mayo Clinic, Jacknsonville, Florida, United States
Disclosure information not submitted.
Ameya Scindia, n/a
Mr.
Mayo Clinic, Jacknsonville, Florida, United States
Disclosure information not submitted.
Abhishek Giri, MBBS
Reserach Trainee
Mayo Clinic, United States
Disclosure information not submitted.
Christan Santos, MSN, FNP-BC
Nurse Practitioner
Mayo Clinic Hospital in Florida
Jacksonville, Florida
Disclosure information not submitted.
philip Lowman, MD
Doctor of Medicine
Mayo Clinic, United States
Disclosure information not submitted.
Pablo MorenoFranco, MD
Assistant Professor of Medicine
Mayo Clinic, United States
Disclosure information not submitted.
Devang Sanghavi, MD, MHA
Mayo Clinic Hospital Jacksonville
Jacksonville, Florida
Disclosure information not submitted.
Title: Molecular Adsorbent Recirculating System (MARS): Is It a Relic of Medical History or a Lifesaver?
Introduction/Hypothesis: Molecular Adsorbent Recirculating System (MARS) is an artificial system that has been used as an extracorporeal hepatic support system that integrates the mechanisms of dialysis, ultrafiltration, and adsorption. It has been used in the improvement of status in patients with liver failure through the removal of accumulated metabolites. The goal of this study is to review the outcomes of the patients who underwent MARS therapy.
Methods: A retrospective analysis of all patients who underwent MARS therapy at our hospital was performed. Patient trends, characteristics, and outcomes were measured. Patient lab reports were also measured and compared before and after MARS sessions to check the efficacy of the therapy. We used paired T-tests to understand the mean differences in variables before and after MARS sessions.
Results: A total of 46 patients underwent MARS therapy during the study period. Among the patients undergoing MARS, 63% were females. The mean length of stay of hospitalized patients was 41.12 ± 78.67 days, the mean number of MARS sessions was 5.4 ± 2.5. Out of total hospitalizations, 58% were discharged and 41% died during hospitalization. About 68% of discharged patients and 13% of deceased patients underwent liver transplant. The most common causes of liver failure were NASH (26%) and alcoholic liver disease (21%). The mean Child-Pugh score for hospitalized patients was 23.5 ± 13.4 and the mean sequential organ failure assessment score was 10 ± 10. Mean MELD Score was 33.8 ± 9.3 before MARS and 32 ± 10.3 after MARS. Furthermore, comparing patients markers before and after MARS therapy, the mean differences in serum bilirubin (mg/dl) (-2.13; CI -4.1-.02; P< 0.05), serum protein (mEq/l) (-1.2 to -2.3; CI -0.26; P< 0.01), serum ammonia (µmol/L) (-41.9; -75.8 to -8.1; P < 0.01) were statistically significant.
Conclusions: In our retrospective review, we observed that most of the patients who underwent MARS therapy had high MELD score, required renal replacement therapy and had improvement in survival after MARS therapy. Majority of these patients underwent liver transplant, Thus MARS is an excellent bridge to liver transplant in eligible candidates. More comprehensive multi-site studies are required to better understand the ideal initiation timing, duration and efficacy of therapy.