Efficacy of Albumin Dialysis to Treat Patients With Hepatic Encephalopathy Using The Molecular Adsorbent Recirculating System (MARS)

Inclusion Criteria: 1. Signed written informed consent by patient or patient's legally appointed representative 2. Be at least 18 years of age; male or female 3. Have chronic end stage liver disease with worsening Hepatic Encephalopathy (Grades 3,4). Exclusion Criteria: 1. Clinically significant bleeding from gastrointestinal or other site within the last 24 hours and requires 2 or more units of blood to maintain a stable hemoglobin level 2. Hemodynamically unstable or on vasopressor agents for blood pressure support (except for renal-dosed dopamine) 3. On acute or chronic hemodialysis or continuous renal replacement therapy (CRRT) 4. Pregnancy 5. Inability to obtain informed consent 6. Uncontrolled sepsis as defined by hemodynamic instability 7. Post-liver transplant 8. Fulminant hepatic failure 9. Irreversible brain damage as indicated by the neurologic examination and CT imaging 10. Endocarditis 11. Pulmonary edema 12. Massive aspiration pneumonia secondary to Hepatic Encephalopathy 13. Active alcohol consumption as determined by a positive blood ethanol level on enrollment/admission 14. Acute main portal vein thrombosis in patients with Hepatocellular Carcinoma