Systematic review of MARS treatment in post-hepatectomy liver failure
Open accessAbstract
Background Post-hepatectomy liver failure (PHLF) remains a serious complication after major liver resection with severe 90-day mortality. Molecular adsorbent recirculating system (MARS) is a potential treatment option in PHLF. This systematic review sought to analyze the experiences and results of MARS in PHLF. Methods Following the PRISMA guidelines, a systematic literature review using PubMed and Embase was performed. Non-randomized trials were assessed by the MINORS criteria. Results 2884 records were screened and 22 studies were extracted (no RCT). They contained 809 patients including 82 patients with PHLF. Five studies (n = 34) specifically investigated the role of MARS in patients with PHLF. In these patients, overall 90-day survival was 47%. Patients with primary PHLF had significantly better 90-day survival compared to patients with secondary PHLF (60% vs 14%, p = 0.03) and treatment was started earlier (median POD 6 (range 2-21) vs median POD 30 (range 15-39); p < 0.001). Number of treatments differed non-significantly in these groups. Safety and feasibility of early MARS treatment following hepatectomy was demonstrated in one prospective study. No major adverse events have been reported. Conclusion Early MARS treatment is safe and feasible in patients with PHLF. Currently, MARS cannot be recommended as standard of care in these patients. Further prospective studies are warranted.
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Aside from salvage liver transplantation, no causal effective therapy exists for advanced liver dysfunction.
“Compared to treatment options in other types of end-stage organ failure such as dialysis in kidney disease, to date, aside from salvage liver transplantation, no causal effective therapy exists for advanced liver dysfunction [8].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [8]
The Discussion says there are no accepted treatment options for post-hepatectomy liver failure (PHLF) beyond supportive and liver-protective care, and identifies transplantation as a possible alternative. The Introduction likewise says no specific treatment is available for PHLF. The cited paper does not establish this broader claim for all advanced liver dysfunction. (LLM, conf=0.86)
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Research works printed but not linked: 7
- Qadan M, Garden OJ, Corvera CU, Visser BC. (2016) Management of postoperative hepatic failure. J Am Coll Surg 222:195-208. HPB 2020, 22, 950-960 © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
- Sen S, Mookerjee RP, Davies NA, Williams R, Jalan R. (2002) Review article: the molecular adsorbents recirculating system (MARS) in liver failure. Aliment Pharmacol Ther 16(Suppl 5):32-38.
- Tsipotis E, Shuja A, Jaber BL. (2015) Albumin dialysis for liver failure: a systematic review. Adv Chronic Kidney Dis 22:382-390.
- Baker MA, Maley WR, Needleman L, Doria C. (2015) Ex vivo resection of hepatic neoplasia and autotransplantation: a case report and review of the literature. J Gastrointest Surg 19:1169-1176.
- Kellersmann R, Gassel HJ, Buhler C, Thiede A, Timmermann W. (2002) Application of Molecular Adsorbent Recirculating System in patients with severe liver failure after hepatic resection or transplantation: initial single-centre experiences. Liver 22(Suppl 2):56-58. HPB 2020, 22, 950-960 © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
- Stutchfield BM, Simpson K, Wigmore SJ. (2011) Systematic review and meta-analysis of survival following extracorporeal liver support. Br J Surg 98:623-631.
- He GL, Feng L, Duan CY, Hu X, Zhou CJ, Cheng Y et al. (2015) Meta- analysis of survival with the molecular adsorbent recirculating system for liver failure. Int J Clin Exp Med 8:17046-17054. HPB 2020, 22, 950-960 © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
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Kofler, A., Trattner, M., Mairinger, V., Urban, I., Søreide, K., Stättner, S., & Primavesi, F. (2025) · Cancers · doi:10.3390/cancers17193120 · Cited by 4 · see citing works
“Compared to treatment options in other types of end-stage organ failure such as dialysis in kidney disease, to date, aside from salvage liver transplantation, no causal effective therapy exists for advanced liver dysfunction [8].”
- Authors
- Sparrelid, E., Gilg, S., & van Gulik, T. M.
- Affiliations
- Karolinska University Hospital (SE)
- Corresponding author
- Sparrelid, Ernesto
- Venue
- HPB
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 22
- Issue
- 7
- Pages
- 950-960
- ISSN
- 1365-182X (ISSN-L)
- OpenAlex
- W3014375113
- Cited by
- 33
- References
- 0
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 5 · 2021: 5 · 2020: 2
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- HPB (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- post-hepatectomy liver failure, molecular adsorbent recirculating system, Mars, liver resection complications, 90-day survival, early treatment initiation, treatment safety and feasibility
- MeSH terms
- Hepatectomy, Humans, Prospective Studies, Liver Failure
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