The sooner the better

(1)

The

sooner

the

better

A guide to MARS

®

(2)

Liver failure and MARS

®

therapy

Indications treated include:

• Acute-on-chronic liver failure

• Acute liver failure, including from drug

overdose and poisoning

• Graft dysfunction after LTx

• Liver failure after liver surgery

• Secondary liver failure

• Intractable pruritus in cholestasis

Developing acute liver failure or deteriorating from a chronic liver

disease, thousands of people are enlisted on liver transplant waiting

lists every year. With a shortage of organs, time becomes extremely

important and management of these patients represents a signiﬁ cant

challenge for physicians around the world.

Gambro, the leading supplier of artiﬁ cial support systems, brings

you the Molecular Adsorbent Recirculating System (MARS) for the

treatment of patients with liver failure.

Liver patients beneﬁ t from getting

support as soon as possible

With early interventions, the MARS system helps prevent the evolution

of irreversible multiorgan failure and facilitates an improved

environ-ment for hepatic regeneration and clinical recovery. The MARS system

removes protein-bound and water-soluble toxins with albumin dialysis.

This reduces plasma toxicity, improves patient clinical conditions

(hemodynamics, hepatic encephalopathy, urine output), enhances the

regeneration of liver cells and may help to recover native liver functions.

Clinically applied since 1993, the MARS system is the most extensively

used non-biological liver support therapy in the world, with an

ever-growing base of clinical experience and evidence. By 2009, more than

9,000 patients from 150 centers in 30 different countries had already been

treated with a safe proﬁ le, and in more than 36,000 performed treatments.

(3)

• Survival

6,7,11

• Hemodynamics

2,5,7,17,18

• Brain function

1,6,8,9

• Kidney function

7 • Liver function

15,20

• Liver recovery in ALF

12,13,15

• Quality of life

14,21,22,23

• Overall therapy costs

24,25

The MARS

system stabilizes

patients and has a positive

impact on:

(4)

MARS

IE 250

MARS

FL

UX

™

DIA FL

UX

MARS

AC 250

How the MARS

®

system works

The MARS system combines the efﬁ cacy of sorbents to remove

albumin-bound toxins with the high selectivity of highly biocompatible dialysis

membranes. In this way, common dialysis or CRRT machines can be

expanded into a modern system for liver support therapy. The blood of

the extracorporeal circuit runs through the ﬁ bers of the MARS FLUX

™

dialyzer. Water-soluble and protein-bound toxins in the blood can pass

through the membrane due to the albumin dialysate on the other side.

The albumin dialysate solution is free from stabilizers when dialysing

the patient.

The now toxin-enriched albumin solution is then passed through another

dialyzer to remove water-soluble toxins. Albumin-bound toxins are

removed in the two adsorber cartridges, one ﬁ lled with activated charcoal,

the other with an anion exchanger. The regenerated albumin solution is

then ready for new uptake of toxins from the blood.

MARS

®

membr

ane

Ion e

x

changer

Activ

ated char

c

oal ﬁ

lter

Dial

ysis membr

ane

Blood circuit

Albumin circuit

Dialysis circuit

Removable protein-bound and

water-soluble substances

26 • Ammonia

• Bilirubin

• Bile acids

• Aromatic amino acids

• Medium and short chain fatty acids

• Tryptophan

• Copper

• Creatinine

• Urea

• Diazepam

(5)

BLOOD

ALBUMIN-DIALYSATE

MEMBRANE

Dialysate

albumin

Plasma-albumin

Albumin-related

binding sites

Protein-layer

Toxic

albumin-associated

compounds,

e.g. bilirubin

weight substance

Section of the semi-permeable

membrane. Water-soluble and

albumin-bound toxins can pass

through.

(6)

Putting you in control of

your patient’s therapy

Features

Combined detoxiﬁ cation:

interaction between the MARS

monitor and standard CRRT

or hemodialysis device.

(See also ’List of allowed device

combinations’ available at your

local sales agent.)

The MARS system is compatible with several hemodialysis machines

and CRRT devices, and requires minimal staff involvement before and

during treatment.

Deliver the prescribed treatment

with high safety standards

• Simultaneous selective removal of albumin-bound and

water-soluble

substances

• High effectiveness and selectivity

• Management of ﬂ uid, electrolyte and acid/base balance

• Control of glucose and lactate level

• High safety standards: safety barrier between patient’s

blood and adsorber columns, cell-free operation,

high biocompatible membrane

• Extracorporeal blood volume limited to one ﬁ lter

• Compatible with a wide range range of renal replacement

equipment

• Features of dialysis and CRRT machines usable

• No major side-effects

• Cost-effective regeneration of the albumin dialysate

ures

ed detoxiﬁ cation:

ion between the MARS

and standard CRRT

odialysis device.

o ’List of allowed device

ations’ available at your

les agent.)

patible with a wide range range of renal replacement

ment

res of dialysis and CRRT machines usable

ajor side-effects

(7)

The next step

Gambro as the leading company

in artiﬁ cial liver support systems

keeps innovating to bring you the

best treatments for the

manage-ment of patients suffering from

liver failure.

1. Hassanein, TI. et al.

Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis. Hepatology. 2007; 46(6):1853-62

2. Laleman, W. et al.

Effect of the molecular adsorbent recirculating system and Prometheus devices on systemic haemodynamics and vasoactive agents in patients with acute-on-chronic alcoholic liver failure. Crit Care. 2006; 10(4):R108

3. Jalan, R. et al.

Pathophysiological effects of albumin dialysis in acute-on-chronic liver failure: a randomized controlled study. Liver Transpl. 2004; 10(9):1109-19

4. El Banayosy, A. et al.

First use of the Molecular Adsorbent Recirculating System technique on patients with hypoxic liver failure after cardiogenic shock. Asaio J. 2004; 50(4):332-7

5. Schmidt, LE. et al.

Systemic hemodynamic effects of treatment with the molecular adsorbents recirculating system in patients with hyperacute liver failure: A prospective controlled trial. Liver Transpl. 2003; 9(3):290-7

6. Heemann, U. et al.

Albumin dialysis in cirrhosis with superimposed acute liver injury: a prospective, controlled study.Hepatology. 2002; 36:949-58

7. Mitzner, SR. et al.

Improvement of Hepatorenal Syndrome With Extracorporeal Albumin Dialysis MARS: Results of a Prospective, Randomized Controlled Clinical Trial

Liver Transpl. 2000; 6:277-286

Other clinical trials

8. Sen, S. et al.

Effect of albumin dialysis on intracranial pressure increase in pigs with acute liver failure: a randomized study. Crit Care Med. 2006; 34(1):158-64

9. Blei, A. et al.

Albumin dialysis for the treatment of hepatic encephalopathy. Journal of Gastroenterology and Hepatology. 2004; 19(0):S224-S228

10. Faybik, P. et al.

Molecular Adsorbent Recirculating System and hemostasis in patients at High risk of bleeding: an observational study. Crit Care. 2006; 10(1):R24

11. Montejo González, JC. et al.

Artiﬁ cial liver support system in acute liver failure patients waiting liver transplantation. Hepatogastroenterology. 2009; 56(90):456-61

12. Camus C. et al.

Liver transplantation avoided in patients with fulminant hepatic failure who

received albumin dialysis with the molecular adsorbent recirculating system while on the waiting list:

impact of the duration of therapy. Ther Apher Dial. 2009;13(6):549-55

13. Kantola, T. et al.

The effect of molecular adsorbent recirculating system treatment on survival, native liver recovery, and need for liver transplantation in acute liver failure patients.

Transpl Int. 2008; 21(9):857-66

14. Javouhey, E. et al.

Long-lasting extracorporeal albumin dialysis in a child with end-stage renal disease and severe cholestasis. Pediatr Transplant. 2008; 13(2):235-9

15. Camus, C. et al.

Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation. Intensive Care Med. 2006; 32(11):1817-25

16. Covic, A. et al.

Successful use of Molecular Absorbent Regenerating System (MARS) dialysis for the treatment of fulminant hepatic failure in children accidentally poisoned by toxic mushroom ingestion. Liver international. 2003; 0(23):21-27

17. Schmidt, LE. et al.

Hemodynamic changes during a single treatment with the Molecular Adsorbent Recirculating System in patients with Acute-on-Chronic.

Liver Transpl. 2001; 7(12):1034-9

18. Sen, S. et al.

Albumin dialysis reduces portal pressure acutely in patients with severe alcoholic hepatitis. J Hepatol. 2005; 43(1):142-8

19. Jalan, R. et al.

Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis. J Hepatol. 2003; 38: 24–31

20. Kjaergard, LL. et al.

Artiﬁ cial and Bioartiﬁ cial Support Systems for Acute and Acute-on-Chronic Liver Failure: A Systematic Review. JAMA. 2003; 289(2):217-22

21. Parés, A. et al.

Extracorporeal albumin dialysis: a procedure for prolonged relief of intractable pruritus in patients with primary biliary cirrhosis. Am J Gastroenterol. 2004; 99(6):1105-10

22. Doria, C. et al.

Effect of molecular adsorbent recirculating system in hepatitis C virus-related intractable pruritus. Liver Transpl. 2003; 9(4):437-43

23. Joannidis, M. et al.

Treatment of refractory cholestatic pruritus after liver transplantation with albumin dialysis. Liver Transpl. 2004; 10(1):107-14

24. Hessel, FP.

Economic evaluation of the artiﬁ cial liver support system MARS in patients with acute-on-chronic liver failure. Cost Eff Resour Alloc. 2006; 4(0):16

25. Hassanein, TI. et al.

Albumin dialysis in cirrhosis with superimposed acute liver injury: possible impact of albumin dialysis on hospitalization costs. Liver International. 2003; 0(23):61-65

26. Mitzner SR. et al.

Albumin dialysis using the molecular adsorbent recirculating system. Curr Opin Nephrol Hypertens 2001;10(6):777-83

Literature on MARS

therapy.

Randomized controlled trials

Effect of albumin dialysis on intracranial pressure increase in pigs with acute a randomized study. Crit Care Med. 2006; 34(1):158-64

9. Blei, A.et al.

Albumin dialysis for the treatment of hepatic encephalopathy. Jour Gastroenterology and Hepatology. 2004; 19(0):S224-S228

10. Faybik, P. et al.

Molecular Adsorbent Recirculating System and hemostasis in High risk of bleeding: an observational study. Crit Care. 2006;

11. Montejo González, JC. et al.

Artiﬁ cial liver support system in acute liver failure patients w transplantation. Hepatogastroenterology. 2009; 56(90):456-6

12. Camus C. et al.

Liver transplantation avoided with fulminant hepatic failure

received albumin dialysis wi molecular adsorbent recirc system while on the waitin impact of the duration of t Ther Apher Dial. 2009;13(6

(8)

o Lundia AB ED

T

A Edition

Partners in care

... David, Ellen, Tom, Enrico, Beatriz. They are just a handful of the

hundreds of thousands of men, women and children around the

world who every day rely on our products and your care to survive

liver or kidney conditions and enjoy a better life. Every step we take

together, every improvement in care we make, touches lives and

provides new hope to José, Xiuxiu, Vladimir, Fred, Jamila ...

Gambro—the pioneer and leading innovator in dialysis therapy

passionately committed to promoting life by advancing products,

services and customer partnership within hepatic and renal care.

Contact us at

partner

@

gambro.com

Gambro®_{and MARS}®_{are registered trademarks of Gambro Lundia AB}

MARS FLUX™_{is a trademark of Gambro Lundia AB, registered in the European Union and pending in the U.S.}