Albumin Dialysis With a Noncell Artificial Liver Support Device in Patients With Acute Liver Failure: A Randomized, Controlled Trial

摘要: Background: Albumin dialysis with the Molecular Adsorbent Recirculating System (MARS) (Gambro, Lund, Sweden), a noncell artificial liver support device, may be beneficial in acute failure (ALF). Objective: To determine whether MARS improves survival ALF. Design: Randomized, controlled trial. (ClinicalTrials.gov: NCT00224705) Setting: 16 French transplantation centers. Patients: 102 patients Intervention: Conventional treatment (n = 49) or conventional 53), stratified according to paracetamol caused Measurements: 6-month and secondary end points, including adverse events. Results: (mean age, 40.4 years [SD, 13]) were modified intention-to-treat (mITT) population. The per-protocol analysis (49 conventional, 39 MARS) included at least 1 session of 5 hours more. Six-month was 75.5% (95% CI, 60.8% 86.2%) 84.9% (CI, 71.9% 92.8%) (P 0.28) mITT population 82.9% 65.9% 91.9%) 0.50) In paracetamol-related ALF, rate 68.4% 43.5% 86.4%) 85.0% 61.1% 96.0%) 0.46) Sixty-six had (41.0% among paracetamol-induced ALF; 79.4% non―paracetamol-induced ALF) < 0.001). Adverse events did not significantly differ between groups. Limitation: short delay from randomization (median, 16.2 hours) precludes definitive efficacy safety evaluations. Conclusion: This randomized trial ALF unable provide conclusions because many before administration intervention. Acute by associated greater patient survival. Primary Funding Source: Assistance Publique―Hopitaux de Paris.