Outcome of patients treated with molecular adsorbent recirculating system albumin dialysis: A national multicenter study

C. Camus (1) , C. Locher (2) , Faouzi Saliba (3) , Bernard Goubaux (4) , Agnès Bonadona (5) , Laurence Lavayssière (6) , Catherine Paugam (7) , Alice Quinart (8) , Olivier Barbot (9) , Sébastien Dharancy (10, 11) , B Delafosse (12) , Nicolas Pichon (13) , Helene Barraud (14) , Arnaud Galbois (15) , Benoît Veber (16) , Sophie Cayot (17) , Bruno Souche (18)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 CIC - Centre d'Investigation Clinique [Rennes]
3 Hôpital Paul Brousse
4 Hôpital l'Archet
5 Hôpital la Tronche
6 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
7 Hôpital Beaujon [AP-HP]
8 Hôpital Pellegrin
9 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
10 Hôpital Claude Huriez [Lille]
11 INFINITE (Ex-Liric) - Institute for Translational Research in Inflammation - U 1286
12 Hôpital Edouard Herriot [CHU - HCL]
13 CHU Dupuytren
14 Hôpital Brabois
15 CHU Saint-Antoine [AP-HP]
16 Hôpital Charles Nicolle [Rouen]
17 CHU Gabriel Montpied [Clermont-Ferrand]
18 CHRU Montpellier - Hôpital Saint Eloi

Background and Aim The molecular adsorbent recirculating system (MARS) is the most widely used device to treat liver failure. Nevertheless, data from widespread real-life use are lacking. Methods This was a retrospective multicenter study conducted in all French adult care centers that used MARS between 2004 and 2009. The primary objective was to evaluate patient survival according to the liver disease and listing status. Factors associated with mortality were the secondary objectives. Results A total of 383 patients underwent 393 MARS treatments. The main indications were acute liver failure (ALF, 32.6%), and severe cholestasis (total bilirubin >340 μmol/L) (37.2%), hepatic encephalopathy (23.7%), and/or acute kidney injury–hepatorenal syndrome (22.9%) most often among patients with chronic liver disease. At the time of treatment, 34.4% of the patients were listed. Overall, the hospital survival rate was 49% (95% CI 44–54%) and ranged from 25% to 81% depending on the diagnosis of the liver disease. In listed patients versus those not listed, the 1-year survival rate was markedly better in the setting of nonbiliary cirrhosis (59% vs 15%), early graft nonfunction (80% vs 0%), and late graft dysfunction (72% vs 0%) (all P < 0.001). Among nonbiliary cirrhotic patients, hospital mortality was associated with the severity of liver disease (HE and severe cholestasis) and not being listed for transplant. In ALF, paracetamol etiology and ≥3 MARS sessions were associated with better transplant-free survival. Conclusion Our study suggests that MARS should be mainly used as a bridge to liver transplantation. Survival was correlated with being listed for most etiologies and with the intensity of treatment in ALF. © 2020 The Authors. JGH Open An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley and Sons Australia, Ltd.

Mots clés: liver transplantation; MARS albumin dialysis; outcome; retrospective study

Domaines: Sciences du Vivant [q-bio]

C. Camus, C. Locher, Faouzi Saliba, Bernard Goubaux, Agnès Bonadona, et al.. Outcome of patients treated with molecular adsorbent recirculating system albumin dialysis: A national multicenter study. JGH Open, 2020, 4 (4), pp.757-763. ⟨10.1002/jgh3.12359⟩. ⟨hal-02931747⟩