***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIM To evaluate treatment safety and hemodynamic changes during a single 6-h treatment with the Prometheus liver assist system in a r and omized , controlled study . METHODS Twenty-four patients were r and omized to either the study group or to one of two control groups : Fractionated Plasma Separation Adsorption and Dialysis , Prometheus system ( Study group ; n = 8) ; Molecular Adsorbent Recirculation System ( MARS ) ( Control group 1 , n = 8) ; or hemodialysis ( Control group 2 ; n = 8) . All patients included in the study had decompensated cirrhosis at the time of the inclusion into the study .  Circulatory changes were monitored with a Swan-Ganz catheter and bilirubin and creatinine were monitored as measures of protein-bound and water-soluble toxins . RESULTS Systemic hemodynamics did not differ between treatment and control groups apart from an increase in arterial pressure in the MARS group ( P = 0.008 ) . No adverse effects were observed in any of the groups . Creatinine levels significantly decreased in the MARS group ( P = 0.03 ) and hemodialysis group ( P = 0.04 ) . Platelet count deceased in the Prometheus group ( P = 0.04 ) . CONCLUSION Extra-corporal liver support with Prometheus is proven to be safe in patients with endstage liver disease but does not exert the beneficial effects on arterial pressure as seen in the MARS group Patients with liver cirrhosis and a superimposed acute injury with progressive hyperbilirubinemia have a high mortality . A prospect i ve , controlled study was performed to test whether hyperbilirubinemia , 30‐day survival , and encephalopathy would be improved by extracorporeal albumin dialysis ( ECAD ) .  Twenty‐four patients were studied ; 23 patients had cirrhosis ; 1 had a prolonged cholestatic drug reaction and was excluded from per protocol ( PP ) analysis . Patients had a plasma bilirubin greater than 20 mg/dL and had not responded to prior st and ard medical therapy ( SMT ) . Patients were r and omized to receive SMT with ECAD or without ( control ) . ECAD was performed with an extracorporeal device that dialyzes blood in a hollow fiber dialyzer ( MW cutoff < 60 kd ) against 15 % albumin . Albumin‐bound molecules transfer to dialysate albumin that is regenerated continuously by passage through a charcoal and anion exchange column and a conventional dialyzer . ECAD was associated with improved 30‐day survival ( PP , 11 of 12 ECAD , 6 of 11 controls ; log rank P < .05 ) . Plasma bile acids and bilirubin decreased on average by 43 % and 29 % , respectively , in the ECAD group after 1 week of treatment , but not in the control group . Renal dysfunction and hepatic encephalopathy improved in the ECAD group , but worsened significantly in the control group . ECAD was safe , with adverse events being rare and identical in both groups . In conclusion , ECAD appears to be effective and safe for the short‐term treatment of patients with cirrhosis and superimposed acute injury associated with progressive hyperbilirubinemia and may be useful for increasing survival in such patients awaiting liver transplantation The Molecular Adsorbent Recirculating System ( MARS ) has been proven to prolong survival in  patients with hepatorenal syndrome .  MARS is a modified dialysis that uses an albumin containing dialysate , which is recirculated and perfused online through charcoal and anion exchanger columns . It allows the selective removal of albumin bound substances . Despite advances in medical therapy and technology , the prognosis of patients with cardiogenic shock remains poor . Mortality rates are as high as 80 % , often because of persistent multiple organ failure . To determine whether patients with hypoxic liver failure after cardiogenic shock after cardiac surgery might benefit from MARS , we performed a prospect i ve , r and omized , controlled , single center study . The primary objective was to prove that MARS improves survival . This article is a report on the interim analysis of the first 27 patients included between August 2000 and December 2001 ; 14 patients were in the MARS group , and 13 patients were in the non-MARS group . All had bilirubin levels greater than 8 mg/ml . Both groups had a similar risk profile . The MARS group received MARS for 3 consecutive days — if bilirubin was still greater than 6 mg/dl afterward , MARS was continued . The non-MARS group received conventional therapy . We had seven survivors in the MARS group ( 50 % ) compared with four ( 32 % ; p = ns ) in the non-MARS group . We conclude that despite the limited number of patients included in this analysis , MARS can be recommended for patients with acute , hypoxic liver failure because it might prolong survival . Further studies in similar patient cohorts are needed to verify our results BACKGROUND Albumin dialysis with the Molecular Adsorbent Recirculating System ( MARS ) ( Gambro , Lund , Sweden ) , a noncell artificial liver support device , may be beneficial in acute liver failure ( ALF ) . OBJECTIVE To determine whether MARS improves survival in ALF . DESIGN R and omized , controlled trial . ( Clinical Trials.gov : NCT00224705 ) . SETTING 16 French liver transplantation centers . PATIENTS 102 patients with ALF . INTERVENTION Conventional treatment ( n = 49 ) or MARS with conventional treatment ( n = 53 ) , stratified according to whether paracetamol caused ALF . MEASUREMENTS 6-month survival and secondary end points , including adverse events . RESULTS 102 patients ( mean age , 40.4 years [ SD , 13 ] ) were in the modified intention-to-treat ( mITT ) population . The per- protocol analysis ( 49 conventional , 39 MARS ) included patients with at least 1 session of MARS of 5 hours or more . Six-month survival was 75.5 % ( 95 % CI , 60.8 % to 86.2 % ) with conventional treatment and 84.9 % ( CI , 71.9 % to 92.8 % ) with MARS ( P = 0.28 ) in the mITT population and 75.5 % ( CI , 60.8 % to 86.2 % ) with conventional treatment and 82.9 % ( CI , 65.9 % to 91.9 % ) with MARS ( P = 0.50 ) in the per- protocol population . In patients with paracetamol-related ALF , the 6-month survival rate was 68.4 % ( CI , 43.5 % to 86.4 % ) with conventional treatment and 85.0 % ( CI , 61.1 % to 96.0 % ) with MARS ( P = 0.46 ) in the mITT population . Sixty-six of 102 patients had transplantation ( 41.0 % among paracetamol-induced ALF ; 79.4 % among non-paracetamol-induced ALF ) ( P < 0.001 ) . Adverse events did not significantly differ between groups . LIMITATION The short delay from r and omization to liver transplantation ( median , 16.2 hours ) precludes definitive efficacy or safety evaluations . CONCLUSION This r and omized trial of MARS in patients with ALF was unable to provide definitive efficacy or safety conclusions because many patients had transplantation before administration of the intervention . Acute liver failure not caused by paracetamol was associated with greater 6-month patient survival . PRIMARY FUNDING SOURCE Assistance Publique-Hôpitaux de Paris In hepatorenal syndrome ( HRS ) , renal insufficiency is often progressive , and the prognosis is extremely poor under st and ard medical therapy . The molecular adsorbent recirculating system ( MARS ) is a modified dialysis method using an albumin-containing dialysate that is recirculated and perfused online through charcoal and anion-exchanger columns . MARS enables the selective removal of albumin-bound substances . A prospect i ve controlled trial was performed to determine the effect of MARS treatment on 30-day survival in patients with type I HRS at high risk ( bilirubin level , > or = 15 mg/dL ) compared with st and ard treatment .  Thirteen patients with cirrhosis with type I HRS were included from 1997 to 1999 . All were Child 's class C , with Child-Turcotte-Pugh scores of 12.4 + /- 1 . 0 , United Network for Organ Sharing status 2A , and total bilirubin values of 25.7 + /- 14.0 mg/dL. Eight patients were treated with the MARS method in addition to hemodiafiltration ( HDF ) and st and ard medical therapy , and 5 patients were in the control group ( HDF and st and ard medical treatment alone ) . None of these patients underwent liver transplantation or received a  transjugular intrahepatic portosystemic shunt  or  vasopressin analogues  during the observation period . In the MARS group , 5.2 + /- 3.6 treatments ( range , 1 to 10 treatments ) were performed for 6 to 8 hours daily per patient . A significant decrease in bilirubin and creatinine levels ( P < .01 ) and increase in serum sodium level and prothrombin activity ( P < .01 ) were observed in the MARS group . Mortality rates were 100 % in the control group at day 7 and 62.5 % in the MARS group at day 7 and 75 % at day 30 , respectively ( P < .01 ) . We conclude that the removal of albumin-bound substances with the MARS method can contribute to the treatment of type I HRS BACKGROUND & AIMS Fractionated plasma separation and adsorption ( FPSA ) is an extracorporeal procedure that supports liver function by removing endogenous toxins that cause complications from acute-on-chronic liver failure ( AOCLF ) . We performed a r and omized trial to investigate survival of patients with AOCLF treated with FPSA .  METHODS Patients with AOCLF were r and omly assigned to groups given a combination of FPSA and st and ard medical therapy ( SMT ) ( FPSA group , n = 77 ) or only SMT ( SMT group , n = 68 ) . The Prometheus liver support system was used to provide 8 to 11 rounds of FPSA ( minimum of 4 hours each ) for 3 weeks . Primary end points were survival probabilities at days 28 and 90 , irrespective of liver transplantation . RESULTS Baseline clinical parameters and number of transplant patients were similar between study arms . Serum bilirubin level decreased significantly in the FPSA group but not in the SMT group . In an intention-to-treat analysis , the probabilities of survival on day 28 were 66 % in the FPSA group and 63 % in the SMT group ( P = .70 ) ; on day 90 , they were 47 % and 38 % , respectively ( P = .35 ) . Baseline factors independently associated with poor prognosis were high SOFA score , bleeding , female sex , spontaneous bacterial peritonitis , intermediate increases in serum creatinine concentration , and combination of alcoholic and viral etiology of liver disease . There were no differences between the 2 groups in the incidence of side effects . CONCLUSIONS Among all patients with AOCLF , extracorporeal liver support with FPSA does not increase the probability of survival . Further studies are needed to assess whether therapy might be beneficial in specific subsets of patients Extracorporeal albumin dialysis ( ECAD ) may improve  severe hepatic encephalopathy ( HE ) in patients with advanced cirrhosis via the removal of protein or non – protein‐bound toxins . A prospect i ve , r and omized , controlled , multicenter trial of the efficacy , safety , and tolerability of ECAD using molecular adsorbent recirculating system ( MARS ) was conducted in such patients . Patients were r and omized to ECAD and st and ard medical therapy ( SMT ) or SMT alone . ECAD was provided daily for 6 hours for 5 days or until the patient had a 2‐ grade improvement in HE . HE grade s ( West Haven criteria ) were evaluated every 12 hours using a scoring algorithm . The primary endpoint was the difference in improvement proportion of HE between the 2 groups . A total of 70 subjects [ median age , 53 ; 56 % male ; 56 % HE grade 3 ; 44 % HE grade 4 ; median model for end‐stage liver disease ( MELD ) 32 ( 11–50 ) and CPT 13 ( 10–15 ) ] were enrolled in 8 tertiary centers . Patients were r and omized to  ECAD  + SMT ( n = 39 ) or SMT alone ( n = 31 ) . Groups were matched in demographics and clinical variables . The improvement proportion of HE was higher in ECAD ( mean , 34 % ; median , 30 % ) versus the SMT group ( mean , 18.9 % ; median , 0 % ) ( P = 0.044 ) and was reached faster and more frequently than in the SMT group ( P = 0.045 ) . Subjects receiving ECAD  tolerated treatment well with no unexpected adverse events . Conclusion : The use of ECAD may be associated with an earlier and more frequent improvement of HE ( grade 3/4 ) . Because this 5‐day study was not design ed to examine the impact of MARS on survival , a full assessment of 
    Output:
    
Because of inconsistency in the reporting of adverse events , the safety analysis was limited but did not demonstrate major safety concerns .
Use of albumin dialysis as supportive treatment for liver failure is successful at removing albumin-bound molecules , such as bilirubin and at improving hepatic encephalopathy .