Plain English Summary
Background and study aims
The study is for serious liver failure patients in in Korea. Molecular Adsorbent Recirculating System (MARS) is used as a liver-assisting device that helps with recovery of liver function. The present study has been planned to find out if MARS can effectively serve as a bridge therapy until liver transplantation in addition to its original use.
Who can participate?
Patients aged between 20 and 70 years with acute liver failure can take part in this study.
What does the study involve?
Patients are randomly allocated to one of two groups: the experimental group or the control group. Patients in the experimental group receive MARS treatment three times in addition to standard internal treatments. Patients in the control group only receive standard internal treatments.
What are the possible benefits and risks of participating?
All patients may find some improvement or delayed aggravation of liver failure. This research may help treatment methods in future. Patients in the experimental group may have changes in blood flow, bleeding and decreased platelet count due to using anticoagulants, which can be a risk for patients with unstable blood flow, bleeding and septic shock (a condition that arises when the blood pressure drops to dangerously low levels). Doctors will carefully observe all patients.
Where is the study run from?
Six hospitals in South Korea:
1. Seoul St. Mary's Hospital
2. Asan Medical Center
3. Soonchunhyang University Hospital, Bucheon
4. Severance Hospital
5. Seoul National University Hospital
6. Pusan National University Hospital
When is the study starting and how long is it expected to run for?
The study started in April 2013 and is expected to run until December 2014.
Who is funding the study?
Gambro Korea Ltd, South Korea.
Who is the main contact?
Dr Jong Young Choi
Dr Jong Young Choi
+82 (0) 2 2258 2151
A prospective study to evaluate the effect of the Molecular Adsorbent Recirculating System (MARS®) for patients with acute liver failure: a randomized controlled study
The study has been planned to determine whether MARS, in adherence to its original function as a liver-assisting device that aids in a recovery of liver functions, is able to effectively serve as a bridge therapy until liver transplantation.
1. Seoul St Mary's Hospital, 13/12/2012, KC12DSMI0703
2. Asan Medical Center, 15/02/2013, 2013-0153
3. Severance Hospital, 21/11/2012, 1-2012-0045
4. Soonchunhyang University Bucheon Hospital, 06/11/2012, SCHBC 2012-02-015-001
5. Seoul National University Hospital, 06/01/2013, D-1210-023-430
6. Pusan National University Hospital, 21/11/2012, H-1210-001-005
Multicenter prospective open-label 1:1 randomized controlled study
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Acute liver failure
Acute on chronic liver failure due to hepatitis B
Upon acquiring the consent form during the subject screening period, the investigator categorizes subjects into groups I, II, III and IV according to the severity grade of hepatic encephalopathy. Half of the subjects are assigned to the experimental group and the other half to the control group in a 1:1, random distribution. Subjects in the experimental group receive equivalent MARS treatment three times in addition to standard internal treatments depending on the study method criteria. Subjects in the control group only receive standard internal treatments. Subjects from both groups may receive subsequent surgical liver transplantation when deemed appropriate by clinicians, unless duly noted due to a potential rejection syndrome in transplantation. Liver transplantation may take place upon consulting clinicians, but it may also be postponed or halted depending on circumstances.
All subjects undergo daily clinical observations and tests for a week starting from the date of study admittance. From thenceforth, patients who have not received liver transplantation undergo clinical observations and tests on the second, third, fourth, twelfth (third month) and sixteenth (fourth month) week of the study. Patients who received liver transplantation undergo clinical observations and tests on the second, fourth, twelfth (third month) and sixteenth (fourth month) week of the study.
Random distribution methods
Random distribution is conducted via a computer system. Once the investigator inputs the data of subjects who meet the inclusion criteria, the computer system conducts a block randomization. Therefore, no one including the investigators themselves can predict which subject will receive which treatment method. The probability of a subject receiving MARS treatment or a standard internal treatment is equal. In categorizing subjects by their severity level in hepatic encephalopathy, a fixed quota is set for each level to ensure distribution.
1. Screening period
The investigator explains the clinical study and its potential risks to subjects and their guardians (legal representatives), who sign and date the consent form upon their agreement of participation. Since subjects in the present study are unable to make decisions on their own due to hepatic encephalopathy, consent by guardians (legal representatives) is required. The subject consent form must be signed before any clinical test procedures take place. The subjects clinical test suitability is screened. This includes clinical laboratory tests on serum chemistry and hematology, analysis on neurologic conditions, special tests and, if needed, EEG. Furthermore, test results and subject information are evaluated in order to determine whether subjects are in full accordance with subject inclusion/exclusion criteria.
2. Treatment period
Upon admittance to the study, the patient is randomly assigned to either the experimental or the control group. Treatment begins within 12 hours. Patients in the control group undergo standard internal treatment. Patients in the experimental group receive three rounds of MARS treatment depending on the study method criteria. In order to apply the MARS treatment, a vascular access must be secured. Vascular access is established in the internal jugular vein, central vein or femoral vein. Upon securing vascular access, MARS® monitor (Gambro) and PRISMA®/PRISMAFLEX® (Gambro) devices are connected prior to the treatment in preparation. The dialysate circuit is primed by 0.9% saline solution. Afterwards, 500 ml 20% albumin is filled into the circuit and recirculation is conducted for over 15 minutes. Blood circuitis are primed with 0.9% saline solution using PRISMA®(Gambro)/PRISMAFLEX® and MARS® monitor devices. Once dialysate recirculation and blood circuit priming is finished, treatment commences. Treatment is conducted for a maximum of 8 hours per session. In case the treatment is discontinued due to a clot in vascular access or other filters, it may resume using new devices when deemed appropriate by the investigator. Any treatment over 5 hours long is considered to be one full round of treatment. All subjects undergo daily clinical observations and tests for a week starting from the date of study admittance. From thenceforth, patients who have not received liver transplantation undergo clinical observations and tests on the second, third, fourth, twelfth (third month) and sixteenth (fourth month) week of the study. Patients who received liver transplantation undergo clinical observations and tests on the second, fourth, twelfth (third month) and sixteenth (fourth month) week of the study.
3. Monitoring period
Subjects who have not received transplantation are traced and monitored for a year starting from the date of the study admittance. Subjects who have received transplantation are traced and monitored for a year starting from the date of the transplantation. Subjects who are to receive transplantation are traced and monitored until transplantation.
Primary outcome measures
6-month survival rate (measured 6 months from the enrolled date of this study)
Secondary outcome measures
1. In case of no transplantation, one-year survival rate from the date of admittance to the study
2. One-year survival rate post-transplantation
3. Survival period length pre-transplantation
4. An improvement in hepatic encephalopathy (using Glasgow Coma Scale in accordance with Appendix 1); measured every day during hospitalization
5. Bilirubin level improvement after MARS treatment; measured at 1 week, 2 weeks, 3 weeks, 4 weeks, 3 months and 6 months using a biochemical test
6. Laboratory parameter improvement; measured at 1 week, 2 weeks, 3 weeks, 4 weeks, 3 months and 6 months using a biochemical test
Overall trial start date
Overall trial end date
Participant inclusion criteria
1. Acute liver failure patient in accordance with American Association for the Study of Liver Diseases (AASLD) guideline
2. Age between 20 and 70
3. Patient with a sign of hepatic encephalopathy
4. If a patient is able to make decisions on his/her own, a subjects own consent and signature is required. However, if a patient is unable to make decisions on his/her own due to hepatic coma, a consent and signature by a legal representative is required.
5. All of the above
6. Or acute-on-chronic liver failure (AoCLF) with hepatitis B including No. 2, 3 and 4 above
Target number of participants
Participant exclusion criteria
1. Acute liver failure due to acetaminophen
2. Acute hepatitis A
3. Patient with a sign of hepatic encephalopathy due to alcoholic hepatitis
4. Patient with anamnesis of chronic liver disease (except hepatitis B)
5. Among autoimmune disease patients with abrupt recurrence, those who display varix and nodularity on CT or duodenoscopy
6. Patient with anamnesis of hepatocirrhosis (except hepatitis B)
7. Septic shock
8. Patient with irreciprocal multiorgan failure
9. Abrupt bleeding
10. Pregnant or lactating women
11. Patient whose mean arterial pressure (MAP) is below 55 mmHg despite usage of hypertensor
12. Coma of non-hepatic origin
13. Uncontrollable sepsis
14. Extrahepatic cholestasis
15. Extrahepatic neoplasia
16. Patient with irreciprocal brain/organ damage leading to transplantation rejection syndrome
17. HIV hepatitis
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Gambro Korea Ltd (Korea, South), Reference No.: MARS01_2012
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Results - basic reporting