Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial

  title={Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial},
  author={Steffen R. Mitzner and Jan Stange and Sebastian Klammt and Teut Risler and Christiane M. Erley and Brigitte Bader and Elke D. Berger and Werner Lauchart and Piotr Peszynski and Jens Freytag and Heiko Hickstein and Jan Loock and Johannes‐Mathias L{\"o}hr and Stefan Liebe and J{\"o}rg Emmrich and Gero Korten and Reinhardt Schmidt},
  journal={Liver Transplantation},
In hepatorenal syndrome (HRS), renal insufficiency is often progressive, and the prognosis is extremely poor under standard medical therapy. The molecular adsorbent recirculating system (MARS) is a modified dialysis method using an albumin‐containing dialysate that is recirculated and perfused online through charcoal and anion‐exchanger columns. MARS enables the selective removal of albumin‐bound substances. A prospective controlled trial was performed to determine the effect of MARS treatment… 
Albumindialyse bei Patienten mit sekundärem Leberversagen nach kardiogenem Schock
It is concluded that despite the limited number of patients included in this analysis, MARS can be recommended for patients with acute, hypoxic liver failure as it can prolong survival.
Outcome of patients treated with molecular adsorbent recirculating system albumin dialysis: A national multicenter study
It is suggested that MARS should be mainly used as a bridge to liver transplantation, and survival was correlated with being listed for most etiologies and with the intensity of treatment in ALF.
Improvement of multiple organ functions in hepatorenal syndrome during albumin dialysis with the molecular adsorbent recirculating system.
  • S. Mitzner, S. Klammt, R. Schmidt
  • Medicine
    Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis
  • 2001
It is concluded that MARS can improve multiple organ functions in patients with HRS and one man underwent successful liver transplantation 18 months after the treatment.
Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute‐on‐chronic liver failure: The RELIEF trial
At scheduled doses, a beneficial effect on survival of MARS therapy in patients with ACLF could not be demonstrated, however, MARS has an acceptable safety profile, has significant dialysis effect, and nonsignificantly improves severe HE.
Albumin dialysis in cirrhosis with superimposed acute liver injury: possible impact of albumin dialysis on hospitalization costs
It appears that the benefits of MARS therapy are enough to justify the cost of treatment and safe hospital costs, at least in the described population, however, further studies are needed to confirm these results.
Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation
A statistically significant improvement of liver function was observed after MARS therapy, andTransplant-free recovery was more frequent than expected and the apparent benefit of MARS dialysis to treat acute liver failure needs to be confirmed by a controlled study.
Anticoagulation minimization is safe and effective in albumin liver dialysis using the molecular adsorbent recirculating system.
Heparin-minimized MARS did not compromise circuit function and longevity in extended intermittent MARS, and priming with heparin saline was safe.


[Successful conservative therapy of hepatorenal syndrome with vasopressin-1-receptor antagonist ornipressin].
This is the first report of successful medical treatment of HRS type I with a three-week infusion of the vasopressin-l-receptor agonist ornipressin.
Long‐term therapy and retreatment of hepatorenal syndrome type 1 with ornipressin and dopamine
Evaluating the therapeutic potential of the vasoconstrictor ornipressin plus dopamine in the treatment of the most severe form of HRS type 1 found it can be a useful therapeutic option in patients with H RS type 1, especially as bridge to liver transplantation.
Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: Effects on renal function and vasoactive systems
In conclusion, TIPS improves renal function and reduces the activity of the renin‐angiotensin and sympathetic nervous systems in cirrhotic patients with type I HRS.
Risk factors and outcome of 107 patients with decompensated liver disease and acute renal failure (including 26 patients with hepatorenal syndrome): the role of hemodialysis.
Thrombocytopenia, encephalopathy, and malignoma, but not HRS per se, are fatal signs that make hemodialysis futile in patients with acute renal failure and decompensated liver disease.
Hepatorenal syndrome: emerging perspectives.
  • M. Epstein
  • Medicine, Biology
    Seminars in nephrology
  • 1997
The acceptance of orthotopic liver transplantation as definitive treatment for patients with end-stage liver disease and attempts to improve renal function by use of transjugular intrahepatic porto-systemic shunt are accepted.
Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide
The long‐term administration of midodrine and octreotide seems to be an effective and safe treatment of type 1 HRS in patients with cirrhosis.
Extracorporeal blood purification in the management of patients with hepatic failure.
A review of the rationale and documented utility of a wide variety of blood purification modalities used in the management of patients with liver failure finds them to be helpful in maintaining fluid, electrolyte, and acid base balance.
Transjugular Intrahepatic Portosystemic Stent Shunt for Hepatorenal Syndrome and Ascites
The recent development of a transjugular intrahepatic portosystemic stent shunt (TIPS) as a treatment for refractory variceal hemorrhage led to the observation that after TIPS placement, concomitant ascites in patients seemed to disappear or became easier to control.