Therapeutic application of molecular adsorbent recirculation system in the treatment of multiple organ dysfunction syndrome patients

Objective To assess the effectiveness of molecular adsorbent recirculation system (MARS) to remove nitric oxide(NO) and cytokines in multiple organ dysfunction syndrome(MODS) in patients with severe liver failure. Methods Single MARS treatment were performed for 198 times with duration ranging from 6 to 24 hours on 61 MODS patients (42M/19F). The efficacy was evaluated by sequential organ failure assessment, biochemical parameters and the levels of proinflammatory cytokines. Results The MARS therapy resulted in a significant removal of NO and certain cytokines such as tumor necrosis factorα(TNFα), interleukin2(IL2), IL6, IL8, and lipopolysaccharidebinding protein(LBP), together with marked reduction of other nonwater soluble albumin bound toxins and water soluble toxins. These were associated with an improvement of the patients' clinical conditions, including deranged hemodynamics, respiratory function, cardiovascular and renal functions, hepatic encephalopathy, thus resulting in a marked decrease of sequential organ failure assessment(SOFA) score and improved outcome. Twentyfive patients were able to be discharged from the hospital, and successful liver transplantation could be performed in 6 patients. The overall survival rate of 61 patients was 41 0%. Conclusion MARS could be used for the treatment of MODS patients associated with elevated levels of NO and cytokines with satisfactory results.