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Molecular adsorbent recirculating system (MARS®) and continuous renal replacement therapy for the treatment of

Romit Saxena1, Emma C Alexander1,2, Sander Bontemps3

  • 1Paediatric Intensive Care, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.

European Journal of Pediatrics
|February 12, 2025
PubMed

Insights

Continuous renal replacement therapy (CRRT) and molecular adsorbent recirculatory system (MARS®) showed similar outcomes for children with paediatric acute liver failure (PALF). Further research is needed to determine the optimal extracorporeal therapy for PALF patients.

Area of Science:

  • Pediatric Intensive Care Medicine
  • Hepatology
  • Nephrology

Background:

  • Paediatric acute liver failure (PALF) management has improved, reducing the need for liver transplantation.
  • Extracorporeal therapies (ECTs) like continuous renal replacement therapy (CRRT) are increasingly used in PALF, but comparisons between different ECTs are limited.

Purpose of the Study:

  • To compare the clinical outcomes of paediatric patients with PALF treated with either CRRT or MARS®.

Main Methods:

  • A retrospective, observational cohort study was conducted across two European pediatric intensive care units (PICUs).
  • Data from 95 PALF patients (23 treated with MARS®, 72 with CRRT) aged 0-18 years were analyzed.
  • Baseline characteristics, biochemical parameters, and clinical outcomes including survival with native liver and overall survival were compared between the MARS® and CRRT groups.

Main Results:

  • The MARS® group had a lower proportion of patients on inotropes or ventilation and a lower Pediatric Index of Mortality 3 risk score at admission compared to the CRRT group.
  • Despite a sicker cohort in the CRRT group, no significant differences were detected in survival with native liver or overall survival between the MARS® and CRRT groups (65.2% for MARS® vs. 68.1% for CRRT).

Conclusions:

  • No significant difference in clinical outcomes was observed between PALF patients treated with CRRT or MARS®.
  • Further high-quality research is required to establish the role of different extracorporeal therapies in PALF, considering outcomes, feasibility, and cost.

Keywords:
Acute liver failureExtracorporeal therapyHyperammonaemiaLiver transplantationPaediatricsSpontaneous recovery

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