Fulminant hepatic failure bridged to liver transplantation with molecular adsorbent recirculating system: a single center experience

Purpose: We herein describe the clinical course of a consecutive series of fulminant hepatic failure patients treated with molecular adsorbent recirculating system, a cell-free albumin dialysis technique. From November 2000 to September 2002, 7 adult patients age 22-61 (median 41), one male (14.2%), and 6 females (85.7%), affected by fulminant hepatic failure, underwent 7 courses (1 to 5 session each, six hours in duration) of extracorporeal support using the molecular adsorbent recirculating system technique. Pre and post treatment blood glucose, liver function tests, ammonia, arterial lactate, electrolytes, hemodynamic parameters, arterial blood gases, liver histology, Glasgow Coma Scale, and coagulation studies, were reviewed. No adverse side effects like generalized bleeding on non-cardiogenic pulmonary edema, often seen during MARS treatment, occurred in the patients included in this study. Results: Six patients (85.7%) are currently alive and well, and one (14.2%) died. Four patients (57%) were successfully bridged (two patients in 1 day and two other patients in 4 days) to liver transplantation, while 2 (28.5%) recovered fully without transplantation. All the measured variables stabilized after molecular adsorbent recirculating system commencement. No differences were noted between the pre and post molecular adsorbent recirculating system liver histology.