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Kidney Week

Abstract: PO0253

Molecular Adsorbent Recirculating System (MARS) Therapy and Outcomes at Mayo Clinic Florida: A Single-Center Experience

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Khan, Mahnoor Mahmud, Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Baker, Lyle Wesley, Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Hickson, LaTonya J., Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
  • Trautman, Christopher L., Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
Background

Molecular adsorbent recirculating system (MARS) is an extracorporeal multi-integrative system, combining the processes of continuous veno-venous hemodiafiltration (CVVHDF) and adsorption, that provides rescue support in fulminant hepatic failure. The use of albumin dialysate within the circuit provides effective removal of circulating toxins which accrue from hepatic failure. Our primary aim was to characterize a cohort of patients who received MARS therapy and renal events, given limited data to date.

Methods

Patients initiating MARS in a tertiary care setting from January 2010 through December 2020 were assessed for treatment indications, transplantation, renal replacement therapy (RRT), renal recovery, and death. Data was collected using the REDCAP software.

Results

During the study period, 49 adult patients (67.3% female; 75.0% White; median age 55 years) received MARS therapy during the study period. Indications included hepatic encephalopathy (55.1 %), primary dysfunction of liver transplant (14.3%), bridge to liver transplant (HRS) (12.2%), acute intoxication or overdose (i.e. acetaminophen) (8.2%), and intractable pruritis in cholestasis (2.0%). A majority (73.4%) of patients received 3 or more MARS treatments (median 3; range 1-10). Following MARS, nearly three-fourths (71.4%) of the cohort required Continuous veno-venous hemofiltration (CVVH) due to acute kidney injury. However, 37.1% recovered renal function prior to discharge. 23 (46.9 %) patients died prior to hospital discharge. Twenty (40.8%) patients received liver transplant during hospitalization. Among those who received liver transplant, a majority (75%) required RRT post transplantation.

Conclusion

MARS therapy though most commonly provided for hepatic encephalopathy is associated with high morbidity and acute kidney failure requiring CVVH. About half may recover renal function sufficient to come off renal replacement therapy but mortality rates are high for all MARS patients.