Clinical Application And Fundamental Study Of MARS In Severe Hepatitis And Liver Transplantation

Objective1.To evaluate the effect of MARS treatment in liver failure of severe hepatitis and liver transplantation.2.To provide diagnostic parameters for liver failure patients who were treating MARS to or not perform liver transplantation.Methods1.67 hepatic failure patients were treated with MARS,changed data in blood were collected before and after every treatment,these laboratory parameters before and after treatment were compared with each other.2.The levels of TNF-αmRNA and IL-6mRNA expression before and after every MARS trentment,both in improving group and worsening group,were tested with RT-PCR.The expresion levels in improving group and worsening group were compared with each other.Results1.MARS therapy achieved a remarkable improvement in clinical symptoms and physic signs;MARS treatment significantly decreased the total bilirubin,total bile acid,creatinine,urea nitrogen,ammonia and endotoxin levels(P < 0.05).2.as well as the serum NO,TNF -α,IL - 4 and IL - 6 levels(P <0.05).3.No significant changes of coagulation factorⅨ(F.Ⅸ) and coagulation factorⅩ(F.Ⅹ) levels were found before and after every single MARS treatment (P > 0.05),however during a serial of MARS treatment,the levels of F.Ⅸand F.Ⅹbefore the latter MARS treatment were higher than the levels before the former MARS treatment(P < 0.05).The levels of F.Ⅸand F.Ⅹincreased during MARS treatment. 4.The survival rate in 49 hepatic failure patients of severe hepatitis B was 61.2% (30/49);8 patients with preoperative hepatic failure were successfully performed liver transplantation:the survival rate in 8 postoperative hepatic failure patients undergone liver transplantation was 37.5%(3/8).5.The levels of TNF-αmRNA and IL-6mRNA expression after every MARS treatment of improving group was significant lower than these of worsening group.Conclusions1.We may confirm the positive therapeutic impact of MARS in hepatic failure patients,and the effectiveness of MARS is correlated with overall removing of elevated levels of toxins,NO and cytokines.2.MARS treatment can improve hepatic synthetic function.3.F.Ⅸand F.Ⅹhave an important value in early evaluation of the prognosis of hepatic failure patients.4.MARS acts as a bridge to the hepatic failure patients who are waiting for liver transplantation.5.The patient can survive by MARS treatment,whose TNF-αmRNA and IL-6mRNA lowly express after MARS treatment.But the patient need liver transplatation whose TNF-αmRNA and IL-6mRNA still highly express after MARS treatment.