Newswise — For patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF), the toxins that build up in their blood can cause confusion, tremors, vomiting, abdominal pain and stomach swelling.
Having a liver unable to clean the body’s blood is a life-threatening condition, and patients are told to seek immediate medical assistance.
The sickest of these patients can die within days without a new liver. Lifesaving mechanical support treatments routinely extend the lives of heart, lung and kidney failure patients, but haven't been an option for liver failure.
Now, doctors at the University of Chicago Medicine have a new treatment to help: Molecular Adsorbent Recirculating System (MARS) therapy, a liver dialysis system that removes waste and toxins from the blood when the liver can no longer do its job. UChicago Medicine is one of the first hospitals in Illinois to offer MARS therapy for patients with ALF and ACLF.
“We’re excited the Transplant Institute has access to another tool to help save lives and support patients until their livers recover or until transplant,” said transplant surgeon Rolf Barth, MD, Director of Liver, Kidney and Pancreas Transplantation and Associate Director of the Transplant Institute.
MARS therapy combines a traditional kidney dialysis machine with the MARS liver dialysis machine. A tube called a catheter is inserted into the patient’s vein; their blood travels through the catheter, then the MARS machine, then the kidney dialysis machine. Special filters in the MARS machine remove toxins that bind to albumin, a protein made by the liver, as well as larger proteins that regular kidney dialysis filters cannot remove.
“MARS does not actively heal or repair a patient's liver,” explained Jay Koyner, MD, Medical Director and Acute Dialysis Director of the ICU Nephrology program. “It does, however, supplement the work of the liver to avoid further toxin buildup and to remove toxins that have already accumulated."
MARS can serve as a bridge so that the patient's liver and kidney laboratory results improve and, with time, normal metabolism can occur, he said. "This buys precious time for a patient's liver to get better," Koyner said.
MARS is the only FDA-approved mechanical device for the treatment of acute liver failure. It is FDA-approved for treating acute liver failure due to drug overdoses and poisoning (the most common being acetaminophen (Tylenol) overdose), as well as liver-related encephalopathy, a condition that can cause serious neurological problems.
Along with other UChicago Medicine colleagues, Barth has also researched the use of MARS for severe liver trauma and as a bridge to transplantation during sudden, unexpected liver failure.
Transplant hepatologist Anjana Pillai, MD, said MARS therapy could be helpful when treating some of UChicago Medicine’s sickest patients. About 30% of UChicago Medicine liver transplant recipients are in the intensive care unit prior to their transplant surgery, compared to 20% nationally.
“Due to our program’s reputation for taking on the sickest cases when it comes to liver transplantation, we are often the referral center for many second and third opinions throughout the state and nationally,” said Pillai, Medical Director of the Liver Tumor Program and Adult Living Donor Liver Transplant Program. “This is why we need to think of out-of-the-box options for our patients to achieve the best outcomes.”
Physicians in hepatology, transplant surgery, critical care and nephrology will work together to manage MARS therapy for patients.
Having a MARS therapy program requires substantial investment in training on the part of dialysis nurses/technicians, ICU nurses and physicians. Koyner said the program would not have been possible without their collective contribution and institutional support.
“I’d love to give credit to the dialysis staff and my colleagues,” said Koyner. “I think MARS therapy has turned into a collaboration that has the potential of accomplishing great things.”
UChicago Medicine is a pioneering institution in the field of organ transplantation, having developed the technique for joining the severed ends of blood vessels in 1904. UChicago Medicine physicians continue to develop groundbreaking procedures in transplantation, including performing the first successful living-donor liver transplant in the United States.
RSS