Transplant-free survival in acute liver failure patients receiving MARS®, plasma exchange or no liver support. A real-life 21-year retrospective cohort study in a referral center

Résumé fourni par la source

BACKGROUND: Whether Molecular Adsorbent Recirculating System (MARS) dialysis and high-volume plasma exchange (HVPE) may improve survival in acute liver failure (ALF) remains unclear. A referral center retrospective cohort study was conducted on patients admitted to ICU with ALF and who fulfilled liver transplantation (LTx) criteria from 2000 to 2021. METHODS: The whole study period was divided into three 7-year consecutive periods (A, B, C) depending on the patients' date of admission. MARS was optionally performed only in periods A and B and HVPE was only performed in period C. Day-21 transplant-free survival (TFS) and day-28 overall survival (OS) were endpoints. The effect of MARS was assessed in periods A and B by comparing the patients treated with MARS with those not treated. Three treatment groups consisting of two different durations of total MARS therapy or no MARS were also compared. HVPE-treated patients (period C, n = 45) were compared to a control group of patients receiving no liver support or a short duration of MARS therapy that was not considered to be effective (over periods A, B, C, n = 126). Survival curves were compared by the Gehan-Breslow-Wilcoxon test and the logrank test. RESULTS: 199 patients were enrolled and distributed as follows: A, n = 68; B, n = 70; C, n = 61. TFS did not differ with and without MARS (p = 0.19). Although MARS duration therapy could not be predicted at the time of MARS initiation, the patients treated ≥ 17 h (≥ 3 sessions) had better survival compared to treatment < 17 h or no MARS (78.6%, 30.4%, 43.8%; p = 0.0002). TFS was 55.6% versus 38.1% in the HVPE- and control groups (p = 0.003; adjusted HR 0.54 [0.32-0.93], p = 0.0257) and OS was 75.9% and 52.9%, respectively (p = 0.03). CONCLUSIONS: MARS therapy improved TFS only in patients who received ≥ 3 sessions. Compared with controls, HVPE-treated patients experienced improved transplant-free and overall survival.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.