Abstract: PUB496
Nephrology Team Leading Molecular Adsorbent Recirculation Therapy (MARS) Therapy: Case Reports
Session Information
Category: Trainee Case Report
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Kovvuru, Karthik, University of Mississippi Medical Center, Jackson, Mississippi, United States
- Kanduri, Swetha Rani, University of Mississippi Medical Center, Jackson, Mississippi, United States
- Castaneda, Jorge Luis, University of Mississippi Medical Center, Jackson, Mississippi, United States
Introduction
Acute liver failure (ALF) from any cause has an extremely high mortality and sometimes liver transplantation is the only final treatment. Molecular Adsorbent Recirculation System (MARS) lead by Nephrology has been successfully used in two patients as a bridge to full recovery and liver transplantation respectively.
Case Description
1) 34 Yr old Female presented with nausea, vomiting with labs significant for AST 15,785 U/L, ALT 10,888 U/L, Total Bilirubin 17.4 mg/dl, INR 2.32. Diagnosed with ALF due to Acute Hepatitis B, was started on N-Acetylcysteine, Lactulose, Rifaximin and Tenofovir. 24 hrs into admission her mentation worsened requiring intubation. CT showed cerebral edema. Decision was made to start MARS to remove toxins and help liver in regeneration by improving microenvironment. Received 56 hrs total of MARS therapy for four days. Bilirubin improved from 25.27 mg/dl to 9.5 mg/dl, mentation improved and was eventually discharged. 2) 28 Yr old Male admitted for ALF secondary to alcohol intoxication. Labs were significant for AST > 7000 U/L, ALT > 7000 U/L, Bilirubin 8.41 mg/dl, Lactate >15 mmol/L. Due to lack of spontaneous recovery and worsening clinical condition he has been started on MARS therapy and listed for Liver transplant. Liver was transplanted after 54 hours of MARS therapy. Surgery related issues complicated his postoperative course. He is currently waiting long term rehab placement for continued recovery.
Discussion
MARS is a potential lifesaving therapy in selected patients. A multidisciplinary team is required to provide this extracorporeal therapy and nephrology should take the lead.