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(Albumin dialysis OR molecular adsorbent recirculating system) AND MARS

Francia C Díaz, Esteban Sáez-González, Salvador Benlloch, Diego Álvarez-Sotomayor, Isabel Conde, Begoña Polo, María García, María Rodríguez, Martín Prieto
:  Background and aims. Steroid-related hepatotoxicity has become one of the most relevant causes of drug induced liver cholestasis. Some patients do not improve after standard medical treatment (SMT) and may therefore require other approaches, like extracorporeal liver support. MATERIAL AND METHODS: We report four cases of patients with pruritus, abnormal liver function tests and biopsy-proven anabolic steroid-induced cholestasis who were unresponsive to SMT. They underwent treatment with albumin dialysis (Molecular Adsorbent Recirculating System -MARS®-)...
November 2016: Annals of Hepatology
Barbara Sinner, Gabriele I Kirchner
Liver failure is a disease with a high mortality rate. Often liver transplantation is the sole therapeutic option. On the one hand, liver support systems probably support the liver to allow regeneration, on the other hand they are an option to bridge for transplantation. This article gives an overview on the clinically used liver assist devices (molecular adsorbent recirculating system [MARS], Prometheus system, single-pass albumin dialysis [SPAD], plasmapheresis) and discusses the applications in liver failure...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Euan Soo, Anja Sanders, Karlheinz Heckert, Tobias Vinke, Franz Schaefer, Claus Peter Schmitt
BACKGROUND: In children acute liver failure is a rare but life-threatening condition from which two-thirds do not recover with supportive therapy. Treatment is limited by the availability of liver transplants. Molecular adsorbent recirculating system (MARS) dialysis is a bridge to transplantation that enhances the chances of survival during the waiting period for a transplant, although it cannot improve survival. Open albumin dialysis (OPAL) is a new mode of albumin dialysis developed to further improve dialysis efficiency...
November 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Luis Ibáñez-Samaniego, María-Vega Catalina, Diego Rincón, Oreste Lo Iacono, Ainhoa Fernández, Gerardo Clemente, Rafael Bañares, Javier Vaquero, Magdalena Salcedo
Patients with severe hepatitis C virus (HCV) recurrence after liver transplantation (LT) present an ominous prognosis, rarely achieving sustained virological response (SVR). Dialysis procedures may transiently decrease the HCV viral load, but the effect of albumin dialysis is currently unknown. Here, we evaluated the impact of albumin dialysis using the Molecular Adsorbent Recirculating System (MARS) used as a co-adjuvant antiviral treatment for severe HCV recurrence after LT. Thirteen patients (11 males, median age 48 years) with fibrosing cholestatic hepatitis or METAVIR fibrosis score ≥ F3 with severe portal hypertension underwent three consecutive MARS sessions...
April 2016: Therapeutic Apheresis and Dialysis
Christoph Sponholz, Katja Matthes, Dina Rupp, Wolf Backaus, Sebastian Klammt, Diana Karailieva, Astrid Bauschke, Utz Settmacher, Matthias Kohl, Mark G Clemens, Steffen Mitzner, Michael Bauer, Andreas Kortgen
BACKGROUND: The aim of extracorporeal albumin dialysis (ECAD) is to reduce endogenous toxins accumulating in liver failure. To date, ECAD is conducted mainly with the Molecular Adsorbents Recirculating System (MARS). However, single-pass albumin dialysis (SPAD) has been proposed as an alternative. The aim of this study was to compare the two devices with a prospective, single-centre, non-inferiority crossover study design with particular focus on reduction of bilirubin levels (primary endpoint) and influence on paraclinical and clinical parameters (secondary endpoints) associated with liver failure...
2016: Critical Care: the Official Journal of the Critical Care Forum
Ashraf A Dahaba
The Bispectral Index™ monitor, an electroencephalographic-derived parameter, can quantify hepatic encephalopathy cerebral function recovery and differentiate between West Haven grades 1 to 4. I report a very peculiar "plateau" phenomenon of 3 clear distinct plateaus of stepwise albumin dialysis Bispectral Index hepatic encephalopathy recovery during an 8-hour Molecular Adsorbent Recirculating System™ (MARS™) liver-assist extracorporeal detoxification, manifesting in conjunction with 3 West Haven grade recoveries...
December 15, 2015: A & A Case Reports
Evangelos Tsipotis, Asim Shuja, Bertrand L Jaber
Albumin dialysis is the best-studied extracorporeal nonbiologic liver support system as a bridge or destination therapy for patients with liver failure awaiting liver transplantation or recovery of liver function. We performed a systematic review to examine the efficacy and safety of 3 albumin dialysis systems (molecular adsorbent recirculating system [MARS], fractionated plasma separation, adsorption and hemodialysis [Prometheus system], and single-pass albumin dialysis) in randomized trials for supportive treatment of liver failure...
September 2015: Advances in Chronic Kidney Disease
Ludovic Gérard, Anne-Cécile Galloy, Arnaud Capron, Philippe Hantson
CASE REPORT: We describe the case of a 58-year-old woman who developed a severe distributive shock following the intentional ingestion of a large overdose of amlodipine (480 mg) combined with valsartan (3680 mg). Extreme vasoplegia remained refractory to maximal standard therapy including fluid resuscitation, intravenous calcium, vasopressors at very high doses, hyperinsulinemia-euglycemia therapy, lipid emulsion, and methylene blue administration. Besides, the patient exhibited hyperglycemia refractory to very high doses of insulin...
July 2015: Clinical Toxicology
Per Olin, John Hausken, Aksel Foss, Tom Hemming Karlsen, Espen Melum, Håkon Haugaa
OBJECTIVE: The molecular adsorbent recirculating system (MARS) is used to purify blood from albumin-bound toxins in patients with liver failure. However, the application of MARS has not demonstrated improved survival in randomized clinical trials and the clinical utility has not been finally established. In our department, the use of MARS is now restricted to the most critically ill patients with acute or acute on chronic liver failure. MATERIAL AND METHODS: Since 2005, we have treated 69 patients (30 males/39 females with median age of 49 years ranging from 1 months to 70 years) listed for liver transplantation (LT) with MARS...
2015: Scandinavian Journal of Gastroenterology
Willem S Lexmond, Carin M L Van Dael, René Scheenstra, Joanne F Goorhuis, Egbert Sieders, Henkjan J Verkade, Patrick F Van Rheenen, Martin Kömhoff
For more than 10 years, children at our national center for pediatric liver transplantation (LT) have been treated with Molecular Adsorbent Recirculating System (MARS) liver dialysis as a bridging therapy to high-urgency LT. Treatment was reserved for 20 patients with the highest degrees of hepatic encephalopathy (HE; median grade = 3.5). Death from neurological sequelae was considered imminent for these patients, and this was further reflected in significantly higher international normalized ratios and ammonia levels and worse prognostic liver indices (Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease scores and liver injury units) in comparison with 32 wait-listed patients who did not receive MARS dialysis...
March 2015: Liver Transplantation
Najla Rustom, Muriel Bost, Fleur Cour-Andlauer, Alain Lachaux, Anne-Sophie Brunet, Olivier Boillot, Fabienne Bordet, Frederic Valla, Nathalie Richard, Etienne Javouhey
OBJECTIVES: Because fulminant Wilson disease (WD) has an extremely poor prognosis, the use of liver support that can bridge patients to liver transplantation is lifesaving. We report the experience of albumin dialysis in acute liver failure (ALF) caused by WD in children. METHODS: Chart review of children admitted for ALF secondary to acute WD and treated by the molecular adsorbents and recirculating system. Measures of copper level in blood and within the circuit during molecular adsorbents recirculating system (MARS) sessions were performed...
February 2014: Journal of Pediatric Gastroenterology and Nutrition
Roberto Marangoni, Giorgio Bellati, Alessandro Castelli, Elisabetta Romagnoli
Molecular Adsorbent Recirculating System (MARS) is a liver support system widely employed in the treatment of liver failure. The method is normally well tolerated. To develop a liver support system combining high efficiency and tolerability, we modified the MARS albumin circuit with the insertion of double adsorption units in parallel. Four patients have been treated with this modified method (high-efficiency MARS, HE MARS): two had very high serum bilirubin and two had very high total bile acids. After a single MARS session bilirubin was reduced more with HE MARS than standard MARS (from 27...
October 2014: Artificial Organs
Adrian Dominik, Jan Stange, Claudia Pfensig, Luise Borufka, Helga Weiss-Reining, Martin Eggert
The removal of small water soluble toxins and albumin-bound toxins in acute liver failure patients (ALF) or acute-on-chronic liver failure (AocLF) patients has been established using extracorporeal liver support devices (e.g. Molecular Adsorbents Recirculating System; MARS). However, reduction of elevated cytokines in ALF/AocLF using MARS is still not efficient enough to lower patients' serum cytokine levels. New membranes with larger pores or higher cut-offs should be considered in extracorporeal liver support devices based on albumin dialysis in order to address these problems, as the introduction of super-large pore membranes could counterbalance high production rates of cytokines and further improve detoxification in vivo...
August 2014: Therapeutic Apheresis and Dialysis
Jean-Marc Regimbeau, David Fuks, Emilie Chapuis-Roux, Thierry Yzet, Cyril Cosse, Eric Bartoli, Eric N'guyen-Khac, Brice Robert, Eric Lobjoie
The preoperative management of hilar cholangiocarcinoma (HC) with jaundice focuses on decreasing the total serum bilirubin level (SBL) by performing preoperative biliary drainage (PBD). However, it takes about 6-8 weeks for the SBL to fall at a sufficient extent. The objective of this preliminary study was to evaluate the impact of Molecular Adsorbent Recirculating System (MARS(®)) dialysis (in association with PBD) on SBL decrease. From January 2010 to January 2011, we prospectively selected all jaundiced patients admitted to our university hospital for resectable HC and requiring PBD prior to major hepatectomy...
2013: Case Reports in Gastroenterology
Faouzi Saliba, Christophe Camus, François Durand, Philippe Mathurin, Alexia Letierce, Bertrand Delafosse, Karl Barange, Pierre François Perrigault, Magali Belnard, Philippe Ichaï, Didier Samuel
BACKGROUND: Albumin dialysis with the Molecular Adsorbent Recirculating System (MARS) (Gambro, Lund, Sweden), a noncell artificial liver support device, may be beneficial in acute liver failure (ALF). OBJECTIVE: To determine whether MARS improves survival in ALF. DESIGN: Randomized, controlled trial. ( NCT00224705). SETTING: 16 French liver transplantation centers. PATIENTS: 102 patients with ALF...
October 15, 2013: Annals of Internal Medicine
M A Ruggero, A C Argento, M S Heavner, J E Topal
The objective of this study was to illustrate the pharmacokinetic removal of piperacillin/tazobactam in an anuric patient on Molecular Adsorbent Recirculating System (MARS(®)). The patient was a 32-year-old woman who presented to a medical intensive care unit with acute liver failure secondary to an acetaminophen overdose. While awaiting transplant, she was started on MARS therapy as a bridge to liver transplant and empirically started on piperacillin/tazobactam therapy. MARS is an extracorporeal hemofiltration device, which incorporates a continuous venovenous hemofiltration (CVVHD) machine linked to an albumin-enriched dialysate filter to normalize excess electrolytes, metabolic waste, and protein-bound toxins...
April 2013: Transplant Infectious Disease: An Official Journal of the Transplantation Society
G A Roth, W Sipos, M Höferl, M Böhmdorfer, E M Schmidt, H Hetz, K Schebesta, D Klaus, M Motal, W Jäger, C G Krenn
BACKGROUND: Adequate plasma antibiotic concentrations are necessary for effective elimination of invading microorganism; however, extracorporeal organ support systems are well known to alter plasma concentrations of antibiotics, requiring dose adjustments to achieve effective minimal inhibitory concentrations in the patient's blood. METHODS: A mock molecular adsorbent recirculating system (MARS) circuit was set using 5000 ml of bovine heparinized whole blood to simulate an 8-h MARS treatment session...
April 2013: Acta Anaesthesiologica Scandinavica
Rafael Bañares, Frederik Nevens, Fin Stolze Larsen, Rajiv Jalan, Agustín Albillos, Matthias Dollinger, Faouzi Saliba, Tilman Sauerbruch, Sebastian Klammt, Johann Ockenga, Albert Pares, Julia Wendon, Tanja Brünnler, Ludwig Kramer, Philippe Mathurin, Manuel de la Mata, Antonio Gasbarrini, Beat Müllhaupt, Alexander Wilmer, Wim Laleman, Martin Eefsen, Sambit Sen, Alexander Zipprich, Teresa Tenorio, Marco Pavesi, Hartmut H-J Schmidt, Steffen Mitzner, Roger Williams, Vicente Arroyo
UNLABELLED: Acute-on-chronic liver failure (ACLF) is a frequent cause of death in cirrhosis. Albumin dialysis with the molecular adsorbent recirculating system (MARS) decreases retained substances and improves hemodynamics and hepatic encephalopathy (HE). However, its survival impact is unknown. In all, 189 patients with ACLF were randomized either to MARS (n=95) or to standard therapy (SMT) (n=94). Ten patients (five per group) were excluded due to protocol violations. In addition, 23 patients (MARS: 19; SMT: 4) were excluded from per-protocol (PP) analysis (PP population n=156)...
March 2013: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Betti Schaefer, Claus Peter Schmitt
The majority of children with acute, acute-on-chronic, and progressive chronic liver failure require liver transplantation. Since organ availability is limited, extracorporeal liver support systems are increasingly applied to bridge the time until transplantation. At present, four different devices are available: the molecular adsorbent recirculating system (MARS), Prometheus dialysis, plasma exchange combined with hemodialysis (PE/HD), and single-pass albumin dialysis (SPAD). Randomized trials in adults have demonstrated efficient toxin removal, improved portal hypertension, hemodynamic stability, and improved hepatic encephalopathy compared with standard medical therapy...
September 2013: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Luiz F Lisboa, Sonal Asthana, Andreas Kremer, Mark Swain, Sean M Bagshaw, Noel Gibney, Constantine J Karvellas
BACKGROUND: The molecular adsorbent recirculating system (MARS) is an albumin-dialysis modality that has been investigated predominantly in patients with acute and acute-on-chronic liver failure. OBJECTIVES: To report the clinical efficacy and safety of MARS therapy for intractable pruritus in cholestasis patients with stable chronic liver disease, characterizing the impact of MARS on cytokine levels and on the transcriptome in the blood compartment. METHODS: MARS therapy was performed on three patients with cholestatic liver disease using 8 h runs for two consecutive days...
November 2012: Canadian Journal of Gastroenterology, Journal Canadien de Gastroenterologie
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