MARS albumin dialysis in toxicology

Abstract

There is a growing interest of both bioartificial and non bioartificial devices to provide a support in patients with liver failure. Albumin dialysis with the Molecular Adsorbent Recirculating System (MARS) is the most used non bioartificial system. Its goal is to remove albumin-bound substances that may play a role in the pathophysiology of liver failure and in the onset of extrahepatic organ failure. The system is also able to decrease plasma concentrations of drugs that bind to albumin.

In toxicology, MARS can be considered in two situations. The first indication is the treatment of acute liver failure from toxic origin, including acetaminophen and amatoxincontaining mushrooms: in this setting, the role of MARS is more to remove hydrophobic toxins produced as consequence of liver failure than to eliminate the initial toxicant. Improvement of hepatic encephalopathy, hemodynamic status, and decreased bilirubin assess MARS-based treatment efficacy. The second indication could be to enhance the elimination of albumin-bound toxicants in cases of severe overdose including phenytoin, theophylline, calcium-channel blockers and valproic acid; however, in this indication, MARS dialysis is still not a widely accepted therapeutic option.

In clinical practice, MARS technique should be used in experienced centers for severe liver failure, particularly those from toxic origin, and more rarely for life-threatening poisonings with albumin-bound drugs, particularly when cardiovascular failure occurs.