Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial

• Published in: Liver transplantation Vol. 6; no. 3; pp. 277 - 286
• Main Authors: Mitzner, Stefan R., Stange, Jan, Klammt, Sebastian, Risler, Teut, Erley, Christiane M., Bader, Brigitte D., Berger, Elke D., Lauchart, Werner, Peszynski, Piotr, Freytag, Jens, Hickstein, Heiko, Loock, Jan, Löhr, Johannes-Mathias, Liebe, Stefan, Emmrich, Jörg, Korten, Gero, Schmidt, Reinhard
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.05.2000
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1053/lv.2000.6355

In hepatorenal syndrome (HRS), renal insufficiency is often progressive, and the prognosis is extremely poor under standard medical therapy. The molecular adsorbent recirculating system (MARS) is a modified dialysis method using an albumin-containing dialysate that is recirculated and perfused online through charcoal and anion-exchanger columns. MARS enables the selective removal of albumin-bound substances. A prospective controlled trial was performed to determine the effect of MARS treatment on 30-day survival in patients with type I HRS at high risk (bilirubin level,15 mg/dL) compared with standard treatment. Thirteen patients with cirrhosis with type I HRS were included from 1997 to 1999. All were Child's class C, with Child-Turcotte-Pugh scores of 12.4 ± 1.0, United Network for Organ Sharing status 2A, and total bilirubin values of 25.7 ± 14.0 mg/dL. Eight patients were treated with the MARS method in addition to hemodiafiltration (HDF) and standard medical therapy, and 5 patients were in the control group (HDF and standard medical treatment alone). None of these patients underwent liver transplantation or received a transjugular intrahepatic portosystemic shunt or vasopressin analogues during the observation period. In the MARS group, 5.2 ± 3.6 treatments (range, 1 to 10 treatments) were performed for 6 to 8 hours daily per patient. A significant decrease in bilirubin and creatinine levels ( P < .01) and increase in serum sodium level and prothrombin activity ( P < .01) were observed in the MARS group. Mortality rates were 100% in the control group at day 7 and 62.5% in the MARS group at day 7 and 75% at day 30, respectively ( P < .01). We conclude that the removal of albumin-bound substances with the MARS method can contribute to the treatment of type I HRS.