Objective To study the clinical effect of molecular adsorption recirculating system in the treatment of septic liver failure. Methods The clinical data of 15 patients with septic liver failure treated with molecular adsorbent recirculating system (MARS) or continuous hemodialysis filtration (CVVHDF) were retrospectively analyzed. All patients received anti-infection treatment including treatment for sepsis, basic diseases and complications. The patients were divided into MARS group and control group according to the treatment method of blood purification. 9 patients in MARS group were treated with MARS for 25 times, with an average of 2.5 times per case. In the control group, 6 patients were treated with CVVHDF 14 times, with an average of 2.3 times per patient. The changes of heart rate, mean arterial pressure, liver function, renal function, coagulation function, inflammatory factors and treatment effect were compared between the two groups before and after treatment. Results After treatment, in MARS group, after stable heart rate (80.96±10.80 vs 89.29±13.44, P=0.041), mean arterial pressure (82.81±7.21 vs 76.64±10.06, P=0.032), bilirubin (151.95±45.18 vs 183.41±38.69, P=0.035), inflammatory factor IL-6 (55.59±29.90 vs 93.47±61.96, P=0.039), and tumor necrosis factor (TNF) were removed- α (19.92±7.54 vs 28.00±9.87, P=0.014) and interleukin-10 (12.55±4.56 vs 19.00±10.08, P =0.038) were significantly superior to the control group. There was no significant difference between MARS group and control group in the clearance of blood ammonia, lactic acid, urea, creatinine and other small molecular substances (P>0.05). There was no significant difference between MARS group and control group in the influence of coagulation function (platelet, PT-INR) (P>0.05). In terms of treatment effect, MARS group was better than the control group (64.00% vs 28.60%, P=0.034). Conclusion Compared with CVVHDF, MARS treatment for septic liver failure has better hemodynamic stability and more comprehensive toxin clearance. It can not only remove protein-bound toxins, but also remove water-soluble small and medium molecular toxins. It is safe in coagulation and has better clinical efficacy