Molecular Adsorbent Recycling System (MARS): Clinical Results of a New Membrane‐Based Blood Purification System for Bioartificial Liver Support

TLDR

Bioartificial liver support systems using xenogenic or engineered cells require blood–bioreactor separation that permits transfer of relevant substances while preventing complications, and because the full toxin spectrum in hepatic failure is unknown, the value of such a membrane separation method was clinically evaluated. The study introduces a membrane separation system that is nearly protein‑impermeable yet allows exchange of water‑soluble and protein‑bound toxins via a special membrane and recycled protein‑containing dialysate. The MARS device was used to treat 13 patients with life‑threatening hepatic failure who had not responded to standard therapy. The therapy achieved a 69 % overall survival rate, with all patients showing a positive response, demonstrating therapeutic efficacy and high safety.

Abstract

The use of xenogenic or genetically engineered cell types in bioartificial liver support systems requires separation methods between the patients' blood and the liver support bioreactors that guarantee the sufficient transfer of pathophysiologically relevant substances but prevent complications. The present paper describes a new membrane separation system that is nearly impermeable to proteins but enables the exchange of water soluble and protein bound toxins by a special membrane and a recycled protein containing dialysate. Because the full range of toxins in hepatic failure has still not been identified, the value of this membrane separation method was evaluated clinically. Thirteen patients suffering from life threatening hepatic failure who had not responded to state of the art therapy were treated with this device, the molecular adsorbent recycling system (MARS). The overall survival rate was 69%. All patients showed positive response to the therapy, indicating that the presented membrane separator combines therapeutic effectivity with the highest safety criteria for the patient by cutting the exchange of substances below the level of proteins.