Global evidence on molecular adsorbent recirculating system uses for trauma-induced acute liver failure: A scoping review.

Abstract

The molecular adsorbent recirculating system (MARS) is an extracorporeal liver support therapy used in acute liver failure, including cases related to trauma; however, evidence supporting its use in trauma-induced liver dysfunction remains limited. This scoping review aimed to systematically map the available literature on the use of MARS therapy in trauma patients and to identify knowledge gaps to guide future research. The review was conducted according to Joanna Briggs Institute methodology and reported in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, with a protocol prospectively registered in the Open Science Framework. Six electronic databases and two clinical trial registries were searched through December 2025, with additional backward citation tracking. Four observational studies met inclusion criteria, comprising 247 patients treated with MARS therapy, of whom only 11 had confirmed trauma-related acute liver failure. No randomized controlled trials were identified. Trauma-specific outcomes were inconsistently reported, and adverse events were not uniformly documented. Survival and liver function recovery varied across studies, and methodological heterogeneity precluded reliable assessment of clinical effectiveness or safety. Current evidence remains sparse and insufficient to support routine clinical use in trauma populations.