UMEM Educational Pearls

Category: Toxicology

Title: Liver dialysis for poisoning-MARS therapy

Keywords: Liver dialysis, MARS (PubMed Search)

Posted: 1/18/2018 by Kathy Prybys, DO (Emailed: 1/19/2018) (Updated: 1/19/2018)
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Acute liver failure carries a high morbidity without liver transplantation. Liver support systems can act as “bridge” until an organ becomes available for the transplant procedure or until the liver recovers from injury. Artificial liver support systems temporally provide liver detoxification utilizing albumin as scavenger molecule to clear the toxins without providing synthetic functions of the liver (coagulation factors). One of the most widely used devices is the Molecular Adsorbent Recirculating System (MARS).This system has 3 different fluid compartments: blood circuit, albumin with charcoal and anion exchange column, and a dialysate circuit that removes protein bound and water soluble toxins with albumin.

  • Mars has been used in several case reports to treat acetaminophen, Amanita phalloides,Phenytoin, lamotrigine, theophylline, and calcilum channel blockers poisonings.
  • All the extracorporeal liver assist devices are able to remove biological substances (ammonia, urea, creatinine, bilirubin, bile acids, amino acids, cytokines, vasoactive agents) but the real impact on the patient's clinical course has still to be determined.

Bottom Line

MARS therapy could be a potentially promising life saving treatment for patients with acute poisoning from drugs that have high protein-binding capacity and are metabolized by the liver, especially when concomitment liver failure. Consider consultation and transfer of patients to liver center.





The Molecular Adsorbent Recirculating System (MARS®) in the Intensive Care Unit: A Rescue Therapy for Patients with Hepatic Failure. F Saliba, Critical Care 10.1 (2006): 118.

Use of the molecular adsorbent recirculating system (MARS™) for the management of acute poisoning with or without liver failure. Whittbole, X, Hantson P. Clin Tox (phila) 2011 Nov;49(9):782-93.
Successful treatment of an adult with Amanita phalloides induced liver failure with molcular absorbent reticulating system (MARS). Lionte C, Sorodoc L, et al.  Rom J Gastroenterol, 2005 vol.14: 267-27 
Survival despite extremely high diltiazem level in a case of acute poisoning treated by MARS. Belleflamme M, el al. Europ J Emmerg Med. 2012/ Feb;19:59-61.