Title: Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: The RELIEF trial
Authors: Bañares, Rafael ×
Nevens, Frederik
Larsen, Fin Stolze
Jalan, Rajiv
Albillos, Agustín
Dollinger, Matthias
Saliba, Faouzi
Sauerbruch, Tilman
Klammt, Sebastian
Ockenga, Johann
Pares, Albert
Wendon, Julia
Brünnler, Tanja
Kramer, Ludwig
Mathurin, Philippe
Mata, Manuel de la
Gasbarrini, Antonio
Müllhaupt, Beat
Wilmer, Alexander
Laleman, Wim
Eefsen, Martin
Sen, Sambit
Zipprich, Alexander
Tenorio, Teresa
Pavesi, Marco
Schmidt, Hartmut H-J
Mitzner, Steffen
Williams, Roger
Arroyo, Vicente #
Contributors: Wauters, Joost
Meersseman, Philippe
Issue Date: Mar-2013
Publisher: W.B. Saunders
Series Title: Hepatology vol:57 issue:3 pages:1153-62
Article number: 10.1002/hep.26185
Abstract: Acute on chronic liver failure (ACLF) is a frequent cause of death in cirrhosis. Albumin dialysis with the molecular adsorbent recirculating system (MARS®) decreases retained substances and improves hemodynamics and hepatic encephalopathy (HE). However, its survival impact is unknown. 189 patients with ACLF were randomized either to MARS® (n=95) or to standard therapy (SMT) (n=94). Ten patients (5 per group) were excluded due to protocol violations. In addition, 23 patients (MARS®: 19; SMT: 4) were excluded from per-protocol (PP) analysis (PP population n=156). Up to ten 6-8 hours MARS® sessions were scheduled. Main endpoint was 28-day ITT and PP survival. There were no significant differences at inclusion, although the proportion of patients with MELD score over 20 points and with SBP as precipitating event was almost significantly greater in the MARS® group. 28-day survival was similar in the two groups in ITT and PP population (60. 7% vs.58.9 %; 60 % vs. 59.2 % respectively). After adjusting by confounders, a significant beneficial effect of MARS® on survival was not observed (OR: 0.87 CI 95 % 0.44-1.72). MELD score and HE at admission and the increase in serum bilirubin at day 4 were independent predictors of death. At day 4, a greater decrease in serum creatinine (p= 0.02) and bilirubin (p=0.001) and a more frequent improvement in HE (from grade II-IV to grade 0-I; 62.5 % vs. 38.2 %; p=0.07) was observed in MARS® group. Severe adverse events were similar. Conclusion: At scheduled doses, a beneficial effect on survival of MARS® therapy in patients with ACLF could not be demonstrated. However MARS® has an acceptable safety profile, has significant dialysis effect and non-significantly improves severe HE. (HEPATOLOGY 2012.).
ISSN: 0270-9139
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Hepatology
Laboratory for Clinical Infectious and Inflammatory Disorders
× corresponding author
# (joint) last author

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