Molecular Absorbents Recirculating System (MARS)

[Guest guest]

Dear Members,

I've posted in the past about my terrible PSC itching. It is 24/7

and can't be controlled by medications. My doctors at UCSF are

using extreme measures such as Plasma Pheresis. It gives some

relief but I'm still tearing myself apart itching.

My Dr. is looking into a procedure called Molecular Absorbents

Recirculating System (MARS) that he thinks could be available on the

east coast. I meet with my doctor in two weeks to discuss this.

Do any of you know where facilities that provide these services are

located? I am currently on the UCSF transplant list however, my

MELD scocre is very low and the rules do not consider pruritis

(itching) as an Exception.

Thanks for any help,

Jan

[Guest guest]

Hi Jan;

The person with the most experience with MARS in the U.S.A. is likely

Dr. Cataldo Doria:

http://www.jeffersonhospital.org/transplant/article3700.html

He has published several articles on MARS:

____________________

Int J Artif Organs. 2003 Oct;26(10):918-23.

Changes in serum electrolytes during treatment of patients in liver

failure with .

Doria C, Doyle HR, Mandalà L, Marino IR, Caruana G, Gruttadauria S,

Lauro A, Magnone M, i Foglieni C, Lamonaca V, VL

Department of Surgery, E. Starzl Transplantation Institute,

University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

cataldo.doria@...

PURPOSE: To study the effect of MARS on serum electrolytes during

liver failure. DESIGN: Twenty-three patients admitted to a quaternary

health care facility from September 2000 to May 2002, 22 adults and 1

child, 11 males (48%) and 12 females (52%), age 15-70 (median 53),

treated with MARS for: 12 acute-on-chronic liver failure (52%); 4

fulminant hepatic failure (17%); 3 intractable pruritus (13%); 2

primary-non-function (9%); 2 following major liver resection (9%).

PROCEDURES: Sodium, potassium, chloride, phosphorus, calcium, and

magnesium were measured in the serum, ultrafiltrate and albumin

circuit before and after MARS. STATISTICAL METHODS: A comparison of

electrolyte concentrations, before and after MARS, was performed

using a paired t test. MAIN FINDINGS: Serum electrolyte

concentrations before and after MARS, while statistically significant

in some cases, were very small, and of no clinical relevance.

CONCLUSION: MARS exchanges potassium, chloride, calcium, and

magnesium by ultrafiltration; sodium by the albumin dialysis. PMID:

14636008.

_____________________

Liver Transpl. 2003 Apr;9(4):437-43.

Effect of molecular adsorbent recirculating system in hepatitis C

virus-related intractable pruritus.

Doria C, Mandalá L, J, Vitale CH, Lauro A, Gruttadauria S,

Marino IR, Foglieni CS, Magnone M, VL.

Department of Surgery, E. Starzl Transplantation Institute,

University of Pittsburgh, and the National Liver Transplant Center of

the Department of Veterans Affairs, PA 15213, USA. doriac@...

Intractable pruritus is more common in cholestatic liver diseases and

may be the presenting symptom and/or major complaint of hepatitis C

and/or hepatitic C virus-related cirrhosis. From September 2000 to

May 2002, three patients affected by intractable pruritus secondary

to hepatitis C cirrhosis that failed medical treatment were treated

with a molecular adsorbent recirculating system (MARS). MARS is an

artificial liver support system that aims to clear the blood of

metabolic waste products normally metabolized by the liver. Each

patient underwent seven MARS sessions. Liver function tests, the 36-

Item Short Form quality-of-life test, visual analog scale for

itching, and bile acid measurement in the serum, albumin circuit and

ultrafiltrate were performed before and after each MARS session.

Moreover, at hospital admission, each patient underwent a

psychological workup and abdominal imaging study. Subjective

improvement in pruritus and quality of life, along with a decrease in

serum bile acid concentration, was observed in every patient; no

patient underwent retreatment and/or liver transplantation up to a 9-

month follow-up. One patient died 201 days after MARS treatment.

Although we observed a decreased level of serum bile acids, one

cannot conclude that this was the mechanism of action for the

reduction in pruritus intensity in patients in our series. Different

toxins and/or a placebo effect might have had a role in this setting.

PMID: 12682899.

________________

Dig Dis Sci. 2006 Jan;51(1):47-53.

Fulminant hepatic failure bridged to liver transplantation with a

molecular adsorbent recirculating system: a single-center experience.

Doria C, Mandalá L, VL, Gruttadauria S, Marino IR

Transplant Division, Department of Surgery, Jefferson Medical College-

Jefferson University Hospital, Philadelphia, Pennsylvania

19107, USA. cataldo.doria@...

We herein describe the clinical course of a consecutive series of

fulminant hepatic failure patients treated with a molecular adsorbent

recirculating system (MARS), a cell-free albumin dialysis technique.

From November 2000 to September 2002, seven adult patients ages 22-61

(median, 41), one male (14.2%) and six females (85.7%), affected by

fulminant hepatic failure underwent seven courses (one to five

sessions each, 6 hr in duration) of extracorporeal support using the

MARS technique. Pre- and posttreatment blood glucose, liver function

tests, ammonia, arterial lactate, electrolytes, hemodynamic

parameters, arterial blood gases, liver histology, Glasgow Coma

Scale, and coagulation studies were reviewed. No adverse side effects

such as generalized bleeding on noncardiogenic pulmonary edema, often

seen during MARS treatment, occurred in the patients included in this

study. Six patients (85.7%) are currently alive and well, and one

(14.2%) died. Four patients (57%) were successfully bridged (two

patients in 1 day and two other patients in 4 days) to liver

transplantation, while two (5%) recovered fully without

transplantation. All the measured variables stabilized after

commencement of the MARS. No differences were noted between the pre-

and the post-MARS histology. We conclude that the MARS is a safe,

temporary life support mechanism for patients awaiting liver

transplantation or recovering from fulminant hepatic failure. PMID:

16416211

___________________

You might consider contacting him to find facilities near you?

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

[Guest guest]

MELD score is very low and the rules do not consider pruritis (itching) as an Exception.

In the UK severe itching like you have is considered a valid reason for transplant. Dr Chapman has said this on a number of occasions esp. at the Oxford Meetings each summer. If I were you I would push hard and see if the drs can be made to change their minds.

I don't know anything about the MARS treatment though.

Hope you get sorted.

Barbara (UK)

[Guest guest]

>

> Hi Jan;

>

> The person with the most experience with MARS in the U.S.A. is likely

> Dr. Cataldo Doria:

>

> http://www.jeffersonhospital.org/transplant/article3700.html

>

> He has published several articles on MARS:

> ____________________

>

> Int J Artif Organs. 2003 Oct;26(10):918-23.

> Chang

> es in serum electrolytes during treatment of patients in liver

> failure with .

>

>Hi & Barbara

Just wanted to thank both of you for taking the time to send me the

information. I'll be seeing the Dr. next week so wish me luck.

Thanks again,

Jan