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Albumin dialysis with artificial liver support beneficial in acute liver failure

A study in this month's Annals of Internal Medicine examines albumin dialysis with a noncell artificial liver support device in acute liver failure.

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Albumin dialysis with the Molecular Adsorbent Recirculating System (MARS) (Gambro, Lund, Sweden), a noncell artificial liver support device, may be beneficial in acute liver failure.

Dr Faouzi Saliba and colleagues from France determined whether MARS improves survival in acute liver failure in 16 French liver transplantation centers of 102 patients with acute liver failure.

The research team compared conventional treatment or MARS with conventional treatment, stratified according to whether paracetamol caused acute liver failure.

The team evaluated 6-month survival and secondary end points, including adverse events.

The team reported that 102 patients were in the modified intention-to-treat population.

66 of 102 patients had transplantation
Annals of Internal Medicine

The per-protocol analysis included patients with at least 1 session of MARS of 5 hours or more.

The research team found that 6-month survival was 76% with conventional treatment, and 85% with MARS in the modified intention-to-treat population.

The team observed that 6-month survival was 76% with conventional treatment, and 83% with MARS in the per-protocol population.

In patients with paracetamol-related acute liver failure, the 6-month survival rate was 68% with conventional treatment, and 85% with MARS in the modified intention-to-treat population.

The research team noted that 66 of 102 patients had transplantation.

Adverse events did not significantly differ between groups.

Dr Saliba's team concluded, "This randomized trial of MARS in patients with acute liver failure was unable to provide definitive efficacy or safety conclusions because many patients had transplantation before administration of the intervention."

"Acute liver failure not caused by paracetamol was associated with greater 6-month patient survival."

Ann Intern Med  2013; 159(8): 522-531
28 October 2013

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