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.

中文翻译：

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MARS治疗肝切除术后肝功能衰竭的系统评价。

背景

肝切除术后肝功能衰竭 (PHLF) 仍然是主要肝切除术后的严重并发症，90 天死亡率很高。分子吸附剂再循环系统 (MARS) 是 PHLF 的潜在治疗选择。本系统评价旨在分析 PHLF 中 MARS 的经验和结果。

方法

遵循 PRISMA 指南，使用 PubMed 和 Embase 进行了系统的文献审查。非随机试验通过MINORS标准进行评估。

结果

筛选了 2884 条记录并提取了 22 项研究（无 RCT）。他们包含 809 名患者，其中 82 名患有 PHLF。五项研究 ( n  = 34) 专门研究了 MARS 在 PHLF 患者中的作用。在这些患者中，90 天的总生存率为 47%。与继发性 PHLF 患者相比，原发性 PHLF 患者的 90 天生存率显着提高（60% 对 14%，p  = 0.03）并且治疗开始得更早（中位 POD 6（范围 2-21）与中位 POD 30（范围 15） –39)；p  < 0.001)。这些组中的治疗次数没有显着差异。一项前瞻性研究证明了肝切除术后早期 MARS 治疗的安全性和可行性。没有报告重大不良事件。

结论

对于 PHLF 患者，早期 MARS 治疗是安全可行的。目前，不能推荐 MARS 作为这些患者的标准护理。进一步的前瞻性研究是有必要的。