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Introduction: Acute liver failure (ALF) is an urgent and life-threatening condition. The molecular adsorbent recycling system (MARS) has been used in the intensive care unit for the last twenty years and allows for the safe and effective removal of albumin-bound and water-soluble substances. Clinically, this was accompanied by stable or improved single organ functions and improved overall status of the patient. Aim: The purpose of this review was the presentation of the effects of MARS in ALF regarding a) hemodynamic variables, b) neurological function and hepatic encephalopathy (HE), c) laboratory indices and d) survival. Method: A literature review was conducted in Medline/PubMed, Scopus and Cochrane library from 1993, when MARS first had been used, until 31/8/2013. The key words used in the literature search were “Acute liver failure”, “MARS”, “Molecular Adsorbent Recycling System”, “extracorporeal support”. The inclusion criteria were a) studies related with the title b) studies in English which were published in journals with peer review system and c) clear methodology including significant clinical outcomes. The search strategy revealed 209 studies. Fourteen were suitable for inclusion, 1 randomized control trial, 1 prospective controlled trial, 4 clinical studies, 4 retrospective studies, 2 prospective observational studies, 1 cohort study and 1 multicenter study. Results: The application of the Molecular Adsorbent Recycling System decreases the levels of bilirubin in patients with ALF, improves hemodynamic indices as well as hepatic encephalopathy. The intervention with MARS may buy time for native liver recovery or serve as bridging therapy to liver transplantation, with reduced risk of cerebral complications. The relation between MARS and survival is still under research. Conclusions: A lack of homogeneity of the patients as well as a variety of different causes for the application of ALF was shown based on the literature search. Despite this, the intervention with MARS seems to improve the clinical condition of the patients with ALF and offers time until a definite therapy, i.e. transplantation, has been procured.