Management of Traumatic Liver Failure Using Molecular Adsorbent Recirculating System (MARS) Treatment.

Traumatic penetrating liver injuries can cause liver failure and subsequent morbidity and mortality. We present a complex case of penetrating hepatic trauma with acute liver failure successfully managed with Molecular Adsorbent Recirculating System (MARS). A twenty-eight-year-old male presented to a level one trauma center after sustaining multiple gunshot wounds. On exploration he had a destructive transhepatic trajectory with central hepatic destruction. After surgery, he was placed on MARS for eight-hour sessions over three consecutive days. His mental status improved, and he was weaned off vasopressors after the first day. He showed improvement in hepatic function including the alpha fetoprotein, ammonia level, international normalized ratio (INR), and total bilirubin. He was later discharged from the hospital to inpatient rehab and eventually home. MARS has a role in the resuscitative strategy of patients with severe penetrating hepatic injuries.