Department of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts 02135, USA.
ASAIO J. 2012 Jan-Feb;58(1):51-9. doi: 10.1097/MAT.0b013e31823fd077.
Molecular Adsorbent Recirculating System (MARS) is an artificial liver support system that has been developed for patients with liver failure until the liver regains function or as a bridge to transplantation. We conducted a meta-analysis to examine the efficacy of this promising therapy. We searched MEDLINE, EMBASE, and the Cochrane Registry of Controlled Trials databases, and abstracts from the proceedings of several scientific meetings. Patients with acute, acute on chronic, and hyperacute liver failure were included and we compared MARS with standard medical therapy. Randomized and nonrandomized controlled trials were included and Molecular Adsorbent Recirculating System was the intervention used. We evaluated net change in total bilirubin levels, improvement in hepatic encephalopathy and mortality. Nine randomized controlled trials and one nonrandomized controlled study met criteria and were included. By meta-analysis, MARS resulted in a significant decrease in total bilirubin levels (net change -7.0 mg/dl; 95% CI -10.4, -3.7; p < 0.001) and in an improvement in the West-Haven grade of hepatic encephalopathy (odds ratio [OR] 3.0; 95% CI 1.9, 5.0; p < 0.001). There was no beneficial effect on mortality (OR 0.91; 95% CI 0.64, 1.31; p = 0.62). The limitations of this study include a small sample size, an inability to blind with significant heterogeneity among studies, and variable definitions of liver failure. The Molecular Adsorbent Recirculating System is associated with a significant improvement in total bilirubin levels and hepatic encephalopathy but has no impact on survival. Large studies are required to assess the merit of this promising therapy on patient-centered outcomes.
分子吸附再循环系统（MARS）是一种人工肝脏支持系统，已开发用于肝功能衰竭的患者，直到肝脏恢复功能或作为移植的桥梁。我们进行了一项荟萃分析，以检查这种有前途的治疗方法的疗效。我们搜索了 MEDLINE、EMBASE 和 Cochrane 对照试验登记处数据库，以及几次科学会议的摘要。纳入了急性、亚急性和超急性肝功能衰竭的患者，并将 MARS 与标准药物治疗进行了比较。纳入了随机和非随机对照试验，分子吸附再循环系统是干预措施。我们评估了总胆红素水平的净变化、肝性脑病的改善和死亡率。符合标准并被纳入的有 9 项随机对照试验和 1 项非随机对照研究。通过荟萃分析，MARS 导致总胆红素水平显著降低（净变化 -7.0mg/dl；95%CI -10.4，-3.7；p < 0.001），肝性脑病的 West-Haven 分级改善（优势比[OR]3.0；95%CI 1.9，5.0；p < 0.001）。死亡率没有有益影响（OR 0.91；95%CI 0.64，1.31；p = 0.62）。本研究的局限性包括样本量小、研究之间存在显著异质性且无法进行盲法以及肝功能衰竭的定义不同。分子吸附再循环系统与总胆红素水平和肝性脑病的显著改善相关，但对生存率没有影响。需要进行大型研究来评估这种有前途的治疗方法对以患者为中心的结局的益处。
