Pugliese F, Novelli G, Poli L, Levi Sandri G B, Di Folco G, Ferretti S, Morabito V, Ruberto F, Berloco P B
Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, La Sapienza Università di Roma, Rome, Italy.
Transplant Proc. 2008 Jul-Aug;40(6):1925-8. doi: 10.1016/j.transproceed.2008.05.077.
The molecular adsorbent recirculating system (MARS) is an extracorporeal acute liver failure (ALF) support system method using albumin-enriched dialysate to remove albumin-bound toxins.
Since 1999 we performed 2027 MARS treatments in 191 patients: 39 fulminant hepatic failure (FHF), 16 primary nonfunction (PNF), 21 delayed function (DF), 94 acute-on-chronic liver failure (AoCHF), 7 post-hepatic resection, and 14 intractable pruritus.
We divided the complications by the AoCHF versus the ALF populations. Among 83 ALF patients, we observed worsening of hemodynamic parameters in 16 patients: 3 with PNF, 2 with DF without retransplantation, 9 with FHF, and 2 after hepatic resection. Among 94 AoCHF patients, 42 showed hemodynamic instability requiring intensive care unit support. Our study did not note significant adverse effects (1.8%), except for infections and hemorrhage from the central venous catheter not due to MARS treatment. The thrombocytopenia was controlled through administration of platelets before the start of treatment when a patient showed a level under 30,000 mm(3).
Our results confirmed that nonbiological hepatic support by MARS was safe and tolerable.
分子吸附再循环系统（MARS）是一种体外急性肝衰竭（ALF）支持系统方法，使用富含白蛋白的透析液去除与白蛋白结合的毒素。
自1999年以来，我们对191例患者进行了2027次MARS治疗：39例暴发性肝衰竭（FHF）、16例原发性无功能（PNF）、21例肝功能延迟恢复（DF）、94例慢加急性肝衰竭（AoCHF）、7例肝切除术后患者以及14例顽固性瘙痒患者。
我们根据AoCHF组与ALF组对并发症进行了划分。在83例ALF患者中，我们观察到16例患者血流动力学参数恶化：3例PNF患者、2例未再次移植的DF患者、9例FHF患者以及2例肝切除术后患者。在94例AoCHF患者中，42例出现血流动力学不稳定，需要重症监护病房支持。除了与MARS治疗无关的中心静脉导管感染和出血外，我们的研究未发现显著不良反应（1.8%）。当患者血小板水平低于30,000/mm³时，在治疗开始前通过输注血小板来控制血小板减少。
我们的结果证实，MARS的非生物性肝支持是安全且可耐受的。
