Pediatric acute liver failure with molecular adsorbent recirculating system treatment

Area of Science:

• Hepatology
• Pediatric Critical Care
• Artificial Liver Support

Background:

• Pediatric acute liver failure (PALF) prognosis has improved with liver transplantation.
• The Molecular Adsorbent Recirculating System (MARS) has been used as a bridging procedure since 2004.

Purpose of the Study:

• To assess the efficacy of MARS as a bridging procedure in children with PALF.
• To evaluate the impact of MARS on clinical status and biochemical markers in pediatric patients with fulminant hepatic failure.

Main Methods:

• MARS treatment was administered to 6 pediatric patients (mean age 10.6 years) with severe fulminant hepatic failure (FHF).
• Inclusion criteria included high bilirubin, creatinine, encephalopathy, and INR levels.
• Patients received continuous MARS treatment with ICU management to optimize recovery and prevent complications.

Main Results:

• Significant improvements were observed in bilirubin, ammonia, creatinine, Glasgow Coma Scale (GCS), SOFA, and PELD scores.
• Two children achieved clinical resolution without liver transplantation.
• Three children underwent liver transplantation (OLT), with two surviving at 14-month follow-up; one died due to nonfunction, and another died from sepsis before OLT.

Conclusions:

• MARS liver support, coupled with experienced ICU management, improves the clinical status of children with PALF awaiting OLT.
• MARS demonstrates potential as a bridging therapy in pediatric acute liver failure, aiding in patient stabilization.