Table 1.
Characteristics of randomized controlled trials included in the meta-analysis
| Reference | Primary outcome | Follow-up | Etiology of liver failure | MARS: SMT (n) | RP (mo) | Treatment | Centers (n) | Treatment regimen | CONSORT score | Allocation | Adverse events (n) | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
| ||||||||||||
| Active | Control | |||||||||||
| Mitzner et al. 2000 [12] | 30 d survival or turn to OLT | 30 d | ALD, chronic HBV, Budd-Chiari/chronic HBV, PBC, secondary biliary cirrhosis | 8:5 | 24 | MARS + HDF + SMT | HDF + SMT | 2 | 6-8 h/treatment, bilirubin level not increased | 16 | Sealed envelope | Severe hepatic encephalopathy (1), mild thrombocytopenia |
| Heemann et al. 2002 [11] | Serum bilirubin | 30 d | Alcoholic hepatitis, HCV, HBV | 12:12 | NR | MARS | SMT | 1 | 8 h/treatment for 3 consecutive d | 17 | Sealed envelope | Anemia (9), hemorrhage (2), hypotension (2), coagulopathy (3), dyspnea (1), paresthesia |
| El Banayosy et al. 2002 [13] | Survival | NR | Cardiogenic shock | 8:9 | 12 | MARS | SMT | 1 | 8 h/d for 3 d, bilirubin < 6 mg/dL | 12 | NR | Thrombocytopenia |
| Schmidt et al. 2003 [19] | Hemodynamics/oxygen consumption | NR | Acetaminophen, HBV, disulfiram | 8:5 | NR | MARS + SMT | SMT + TM | 1 | 6 h per treatment | 10 | NR | Arterial hypotension |
| El Banayosy et al. 2004 [14] | Survival | NR | Cardiogenic shock | 14:13 | 16 | MARS | SMT | 1 | 8 h/d for 3 d, bilirubin < 6 mg/dL | 11 | NR | Thrombocytopenia, hepatorenal syndrome |
| Sen et al. 2004 [18] | Clinical and biochemical | NR | Alcoholic liver disease | 9:9 | NR | MARS + SMT | SMT | 1 | 8 h/d for 7 d | 15 | Sealed envelope | Variceal bleeding, multiorgan failure |
| Hassanein et al. 2007 [23] | HE | 180 d | Cirrhosis and HE grade 3 or 4 | 39:31 | 39 | MARS + SMT | SMT | > 1 | 6 h/d for 5 d | 20 | Blinded envelope | Hepatic encephalopathy, GI bleeding, hypotension |
| Hessel et al. 2010 [22] | Survival | 3 y | Alcoholic liver disease, infections/intoxications, autoimmune hepatitis | 67:82 | 51 | MARS + SMT | SMT | 1 | until death | 14 | NR | NR |
| Saliba et al. 2013 [21] | Survival | 1 y | Paracetamol, non-paracetamol | 53:49 | 40 | MARS + SMT | SMT | 16 | 6 h/d for 3 d | 20 | Central automated system | Neurologic, psychiatric, and renal disorders |
| Banares et al. 2013 [20] | Survival | 90 d | Alcohol, HCV + alcohol | 90:89 | 71 | MARS + SMT | SMT | 19 | 6 h/d for 21 days | 19 | Randomization system | Bacterial infection, variceal bleeding, pneumonia |
Abbreviations: CONSORT, Consolidated Standards of Reporting Trials; GI, gastrointestinal; HBV, hepatitis B virus; HCV, hepatitis C virus; HDF, hemodiafiltration; HE, hepatic encephalopathy; MARS, molecular adsorbent recirculating system; NR, not reported; OLT, orthotopic liver transplantation; PBC, Primary biliary cirrhosis; RP, recruitment period; SMT, standard medical treatment; TM, temperature-matched.