J Gastroenterol Hepatol. 2020 Sep 12. doi: 10.1111/jgh.15255. Online ahead of print.
BACKGROUND AND AIM: Artificial liver systems are used to bridge between transplantation or to allow a patient's liver to recover. They are used in patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). There are five artificial systems currently in use; molecular adsorbent recirculating system (MARS), single-pass albumin dialysis (SPAD), Prometheus, selective plasma filtration therapy (SEPET) and hemodiafiltration. The aim is to compare existing data on the efficiency of these devices.
METHODS: A literature search was conducted using online libraries. Inclusion criteria included randomised control trials or comparative human studies published after the year 2000. A systematic review was conducted for the five individual devices with a more detailed comparison of the biochemistry for the SPAD and MARS systems.
RESULTS: 89 patients were involved in the review comparing SPAD and MARS. Results showed that there was an average reduction in bilirubin (-53μmol/L in MARS and -50μmol/L in SPAD), creatinine (-19.5μmol/L in MARS and -7.5μmol/L in SPAD), urea (-0.9mmol/L in MARS and -0.75mmol/L in SPAD) and GGT (-0.215μmol/L.s in MARS and -0.295μmol/L.s in SPAD) in both SPAD and MARS. However, there was no significant difference between the changes in the two systems.
CONCLUSIONS: This review demonstrated that both MARS and SPAD aid recovery of ALF. There is no difference between the efficiency of MARS and SPAD. Due to the limited data, there is a need for more randomised control trials. Evaluating cost and patient preference would aid in differentiating the systems.