The Molecular Adsorbent Recirculating System (MARS®) in the intensive care unit: a rescue therapy for patients with hepatic failure

Treatment in the intensive care unit of patients with end-stage liver disease has been limited. Liver transplantation has been a major improvement in this and has become standard in the management of these patients. However, many patients die awaiting liver transplantation, mainly due to the scarcity of organ donors. Conventional hemodialysis techniques have little or no effect on liver detoxification and do not improve the prognosis of these patients. In patients with acute hepatic failure, the majority of endogenous toxins leading to organ failure and accumulating in the blood are bound to albumin; therefore, the concept of albumin dialysis is of major interest. To date, the most widely developed system has been the Molecular Adsorbent Recirculating System (MARS), which is based on the selective removal of albumin-bound toxins from the blood. MARS enables simultaneous liver and kidney detoxification, improving the patient's clinical condition. It is a major improvement in the management of patients with hepatic failure that could permit, when appropriately indicated, recovery from an acute episode and enhance the chances of survival while waiting for an available organ donor.