Use of MARS in Hepatorenal Syndrome — A Local Perspective

Hepatorenal syndrome is a complication of liver failure with high mortality. All existing treatments, short of liver transplantation, can only be considered as supportive. The molecular adsorbent recirculation system (MARS) is a modified dialysis technique that can remove bilirubin and other albumin-bound toxins, and is now widely used as an artificial liver support system. MARS has been evaluated in many studies, although most have been observational rather than randomized controlled trials. MARS has been demonstrated to be effective in attenuating serum bilirubin, ammonia, creatinine and other hepatotoxin levels in patients, but the biochemical improvement has not been accompanied by an improvement in patient survival. Factors that affect the outcome of patients include timing of implementation, nature of the liver diseases treated, and availability of liver transplantation. MARS preconditioning is another possible indication that aims to improve the postoperative outcome in elective live donor liver transplantation. In the future, randomized controlled trials will be necessary to ascertain the specific role of MARS in the management of liver failure.