| Objective: to evaluate the efficiency of Molecular Adsorbents Recycling System (MARS) in the treatment of severe hepatitis and to study the clinical use of the Model for End-Stage Liver Diease(MELD). Method: 27 patients with severe hepatitis were treated with MARS 49 times combined with standard medical treatment in Xin Jiang Special Hospital for Liver Disease during March 2002 and March 2004. In these patients, M/F 21/6 ,the range of age was 28-74( 45.48 ± 13.87) ys,3 patients with subacute severe hepatitis ,24 patients with chronic sever hepatitis (the criterion according to the prevention and cure plan of virus hepatitis in china) .The number of complicating Hepatolencephalopathy (HE), Hepatalrenal syndrome(HRS) and Spontaneous bacterial peritonitis (SBP) were all 10 respectively . Average level of CTP score was 11.7 ± 1.77(B: 13 ; C: 14), average level of MELD score was 31.86±11.61 (10-19 :2 cases ; 20-29:13 cases; 30-39:5 cases; ≥40:7 cases). MARS therapy 6-8h/per time plus standard medical treatment, the therapy parameter of MARS : the blood flow rate was set at 150ml/min ,the albumin circuit (containing 500ml 20% HRS)was driven at 150ml/min and dialysate flow was set at 500ml/min. Blood chemical data were collected before and after every treatment .All of the patients graded with MELD before and after MARS and the mortality were observed three months later. Results: MARS therapy achieved a remarkable improvement in clinical symptoms and physic signs ,accomplished with significant decrease in albumin bound toxins and water soluble toxins.Compared with pretreatment ,the concentration of TBil ,TBA and ALT in the sera were much lower than post-treatment (from 468.20±165.81 , 127.7±82.37, 173.24±88.48 decreased to 369.08±144.95, 80.96±63.73, 162.51±78.58 respectively P< 0.001) .The level of creatinine was decreased, it has significance in statistics (from 111±86.46 decreased to 90.07±71.82 P<0.05) .Together with significant decrease the International Normalized Ratio(INR) for prothrombin time (from 3.66±2.79 decreased to3.27±2.45 P<0.05) .MARS have no effect on blood routine.7 cases with MELD score higher than 40 before treatment of MARS were all dead in 3 months , the reality equal to the prediction of the 3-month mortality; 5 cases with MELD score between 30 and 40 remaind a death rate of 80% (the prediction death rate was 83% P>0.05);13 patients with MELD score from 20 to 29 ,the reality death rate were significant decreased (from76% to 23% P<0.01) after MARS, no patients dead in 2 cases with MELD score from 10 to 19 (the reality death rate decreased from 27% to 0 % P<0.01 ). For the patients with MELD less than 40, the reality death rate remarkably decreased from 80% to 35% after MARS treatments(P<0.01). In short , after MARS treatment, overall death rate of 27 patients was 51.9% that less than the prediction of mortality :78% (P<0.05) .MARS treatment results in a significant decrease of the average MELD score (from 32.37±11 to 27.4±10.7 P<0.01) .13 patients recovered, the survival rate of 3-month was 48.1%; 14 cases died in 3 months:7 cases died of HE,4 died of acute renal failure,2 died of upper gastrointestinal hemorrhage, In addition, 1 died from cor pulmonale. Conclusion: As a hepatic support device, MARS is a useful way for therapy of severe hepatitis; MELD can be applied in clinic for evaluating severity of severe hepatitis and effect of MARS treatment; MARS can be used safely and efficiently to treat end-stage liver disease with MELD score less than 40 ( best for MELD score less than 30) .
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