%0 Journal Article
%T The Molecular Adsorbent Recirculating System (MARS£¿) in the intensive care unit: a rescue therapy for patients with hepatic failure
%A Faouzi Saliba
%J Critical Care
%D 2005
%I BioMed Central
%R 10.1186/cc4825
%X During the past decades, few therapeutic measures have been developed for the treatment of patients with end-stage liver disease. Despite a great improvement in the field of transplantation, the mortality in patients developing hepatic failure remains very high and many patients die while awaiting liver transplantation. In recent years, a major interest has been the replacement of the liver by extracorporeal systems that may provide a lifeline until a spontaneous recovery of the liver or until an appropriate donor is available. Many non-biological liver support therapies based on detoxification of the patient's blood have been developed. These include standard or high-flux hemodialysis, continuous veno-venous hemofiltration or hemodiafiltration, charcoal perfusion, hemadsorption with non-biological adsorbents and plasma or blood exchange [1-4]. To date, the most widely developed system has been the Molecular Adsorbent Recirculating System (MARS£¿), which uses albumin dialysis to mainly replace the detoxification function of the liver. Two other systems using a similar approach have been developed recently, the Prometheus£¿ and the Single-Pass Albumin Dialysis (SPAD£¿) systems; few patients have been treated with these systems to date, but their results could be promising [5,6].MARS£¿ is a liver support system that uses an albumin-enriched dialysate to facilitate the removal of albumin-bound toxins. The system has three different fluid compartments: a blood circuit, a circuit containing 600 ml of 20% human albumin with a charcoal column and an anion exchange resin column and a dialysate circuit [7]. MARS£¿ requires a standard dialysis machine or a continuous veno-venous hemodiafiltration device (CCVVHD) to control the blood and dialysate circuits.MARS£¿ has been used in the intensive care unit in most clinical situations of hepatic failure [8,9]. The main indications of treatment with MARS£¿ are now better established but they need further validation; they are summarized in
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