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Background <p>Whether Molecular Adsorbent Recirculating System (MARS) dialysis and high-volume plasma exchange (HVPE) may improve survival in acute liver failure (ALF) remains unclear. A referral center retrospective cohort study was conducted on patients admitted to ICU with ALF and who fulfilled liver transplantation (LTx) criteria from 2000 to 2021. </p> Methods <p>The whole study period was divided into three 7-year consecutive periods (A, B, C) depending on the patients’ date of admission. MARS was optionally performed only in periods A and B and HVPE was only performed in period C. Day-21 transplant-free survival (TFS) and day-28 overall survival (OS) were endpoints. The effect of MARS was assessed in periods A and B by comparing the patients treated with MARS with those not treated. Three treatment groups consisting of two different durations of total MARS therapy or no MARS were also compared. HVPE-treated patients (period C, n = 45) were compared to a control group of patients receiving no liver support or a short duration of MARS therapy that was not considered to be effective (over periods A, B, C, n = 126). Survival curves were compared by the Gehan-Breslow-Wilcoxon test and the logrank test.</p> Results <p>199 patients were enrolled and distributed as follows: A, n = 68; B, n = 70; C, n = 61. TFS did not differ with and without MARS (p = 0.19). Although MARS duration therapy could not be predicted at the time of MARS initiation, the patients treated ≥ 17&#xa0;h (≥ 3 sessions) had better survival compared to treatment &lt; 17&#xa0;h or no MARS (78.6%, 30.4%, 43.8%; p = 0.0002). TFS was 55.6% versus 38.1% in the HVPE- and control groups (p = 0.003; adjusted HR 0.54 [0.32−0.93], p = 0.0257) and OS was 75.9% and 52.9%, respectively (p = 0.03).</p> Conclusions <p>MARS therapy improved TFS only in patients who received ≥ 3 sessions. Compared with controls, HVPE-treated patients experienced improved transplant-free and overall survival.</p>

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Transplant-free survival in acute liver failure patients receiving MARS®, plasma exchange or no liver support. A real-life 21-year retrospective cohort study in a referral center

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  • 发表日期：

    2025年8月26日

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  • Kieran Pinceaux,
  • Félicie Bélicard,
  • Valentin Coirier,
  • Estelle Le Pabic,
  • Pauline Guillot,
  • Flora Delamaire,
  • Benoît Painvin,
  • Quentin Quelven,
  • Mathieu Lesouhaitier,
  • Adel Maamar,
  • Arnaud Gacouin,
  • Pauline Houssel-Debry,
  • Karim Boudjema,
  • Edouard Bardou-Jacquet,
  • Jean-Marc Tadié,
  • Florian Reizine,
  • Christophe Camus

摘要

Background

Whether Molecular Adsorbent Recirculating System (MARS) dialysis and high-volume plasma exchange (HVPE) may improve survival in acute liver failure (ALF) remains unclear. A referral center retrospective cohort study was conducted on patients admitted to ICU with ALF and who fulfilled liver transplantation (LTx) criteria from 2000 to 2021.

Methods

The whole study period was divided into three 7-year consecutive periods (A, B, C) depending on the patients’ date of admission. MARS was optionally performed only in periods A and B and HVPE was only performed in period C. Day-21 transplant-free survival (TFS) and day-28 overall survival (OS) were endpoints. The effect of MARS was assessed in periods A and B by comparing the patients treated with MARS with those not treated. Three treatment groups consisting of two different durations of total MARS therapy or no MARS were also compared. HVPE-treated patients (period C, n = 45) were compared to a control group of patients receiving no liver support or a short duration of MARS therapy that was not considered to be effective (over periods A, B, C, n = 126). Survival curves were compared by the Gehan-Breslow-Wilcoxon test and the logrank test.

Results

199 patients were enrolled and distributed as follows: A, n = 68; B, n = 70; C, n = 61. TFS did not differ with and without MARS (p = 0.19). Although MARS duration therapy could not be predicted at the time of MARS initiation, the patients treated ≥ 17 h (≥ 3 sessions) had better survival compared to treatment < 17 h or no MARS (78.6%, 30.4%, 43.8%; p = 0.0002). TFS was 55.6% versus 38.1% in the HVPE- and control groups (p = 0.003; adjusted HR 0.54 [0.32−0.93], p = 0.0257) and OS was 75.9% and 52.9%, respectively (p = 0.03).

Conclusions

MARS therapy improved TFS only in patients who received ≥ 3 sessions. Compared with controls, HVPE-treated patients experienced improved transplant-free and overall survival.