Eighteen patients with
fulminant hepatic failure due to various medical causes were listed for emergency
liver transplantation and treated with extracorporeal
albumin dialysis sessions using the molecular adsorbent recirculating system (MARS) at our center over a 74-month period. Due to improvement of liver function,
transplantation could be avoided in 9 patients (50%, 95% confidence interval 29% to 71%) who fully recovered afterwards. This improvement rate was higher than the rate of improvement in the French cohort of
fulminant hepatic failure patients with similar etiologies (19.3%, 95% confidence interval 14.9% to 24.6%, P = 0.002). In our 18 patients, there were no statistically significant differences in any baseline characteristics or in the time with
liver failure meeting transplant criteria between the patients who improved while waiting and those who did not. However, the patients who improved received a greater number of sessions and a longer total duration of MARS
therapy (all P < 0.001). In the whole study population, a MARS
therapy duration > or =15 h was significantly associated with improvement of liver function without
transplantation (adjusted adds ratio [OR] 65.76, 2.48-1743.11, P = 0.01). Tolerance of
therapy was acceptable. These results suggest that MARS
therapy could contribute to native liver recovery and is safe in patients on the waiting list for
fulminant hepatic failure. A minimum
duration of therapy (> or =15 h) could be necessary to expect significant liver function improvement.