ArticleAnnals of intensive care2025
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.
Article in Annals of intensive care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 2 papers.
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2 citing papers in PubMed.
- Association between hemoglobin-to-red blood cell distribution width ratio trajectory patterns and in-hospital mortality in critically ill patients with cirrhosis: a retrospective cohort study based on MIMIC-IV and eICU-CRD.BMC medical informatics and decision making · 2026Article
- [Advantages and challenges of auxiliary liver transplantation therapeutic strategies for patients with acute liver failure].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Article
Corrections and comments
- Erratum issued
Authors and funding
17 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhether 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.
methodsThe 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.
results199 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).
conclusionsMARS therapy improved TFS only in patients who received ≥ 3 sessions. Compared with controls, HVPE-treated patients experienced improved transplant-free and overall survival.
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