Review article: the Molecular Adsorbents Recirculating System (MARS) in liver failure

SUMMARY In recent years different artificial liver support systemsare being developed for use in patients with acutedecompensation of chronic liver disease or acute liverfailure. The molecular adsorbents recirculating system(MARS), a device in which patient’s blood is dialysedacross an albumin-impregnated membrane against arecirculated albumin-containing solution, seems to beeffective in removing albumin-bound toxins, such asfatty acids, bile acids and bilirubin. Although theclinical experience with MARS is scarce, some pilotstudies have reported its effectiveness at improving liverfunction and hepatic encephalopathy in patients withacute decompensation of chronic liver disease, andrenal function in patients with hepatorenal syndrometype I. Data regarding MARS experience in acute liverfailure and in primary graft dysfunction are encoura-ging but limited. Its real usefulness in these settings is,at present, under evaluation in randomized controlledclinical trials. BACKGROUND Liver failure can occur either as an acute liver failurewithout any pre-existing liver disease, an acutedecompensation of chronic liver disease (acute-on-chronic liver failure; ACLF) or as a chronic decompen-sation in end-stage liver disease. They have differentcauses or precipitating factors, and the underlyingpathophysiological mechanisms may also differ. How-ever, they manifest clinically in fairly similar fashions,with hepatic encephalopathy, hepatorenal syndromeand circulatory changes.