Albumin dialysis: current practice and future options.

The current management of patients with severe liver failure encompasses treatment of the precipitating event and supportive therapy for extra-hepatic end-organ dysfunction while waiting for the liver to recover or for a suitable graft to become available. Molecular Adsorbent Recirculating System (MARS) is an extracorporeal detoxification device that allows the save and effective removal of albumin-bound as well as water-soluble substances in an effort to overcome phases of critical organ dysfunction or to bridge patients until transplantation. MARS has proven to be a useful treatment in patients with acute-on-chronic liver failure and acute liver failure for improving biochemical parameters and clinical symptoms but benefits in patient outcome have not yet been fully demonstrated. The optimal timing for initiation, frequency and duration of MARS treatment, and the biochemical and clinical parameters on which to base clinical decisions, remain partially unanswered issues.