Experience with molecular adsorbent recirculating system treatment in 20 children listed for high‐urgency liver transplantation

Abstract

For more than 10 years, children at our national center for pediatric liver transplantation (LT) have been treated with Molecular Adsorbent Recirculating System (MARS) liver dialysis as a bridging therapy to high-urgency LT. Treatment was reserved for 20 patients with the highest degrees of hepatic encephalopathy (HE; median grade 5 3.5). Death from neurological sequelae was considered imminent for these patients, and this was further reflected in significantly higher international normalized ratios and ammonia levels and worse prognostic liver indices (Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease scores and liver injury units) in comparison with 32 wait-listed patients who did not receive MARS dialysis. MARS therapy was generally well tolerated, with a reduction in thrombocytes and hemorrhaging as the most common side effects. HE improvement was documented in 30% of the treated patients, but progression to grade IV encephalopathy occurred in 45% of the patients despite the treatment. Serum ammonia, bilirubin, bile acid, and creatinine levels significantly decreased during treatment. Eighty percent of MARS-treated patients survived to undergo LT, and their survival was equivalent to that of non-MARStreated patients with severe liver failure (69%, P 5 0.52). The heterogeneity between MARS-treated patients and non-MARStreated patients in our cohort precluded a statistical evaluation of a benefit from MARS for patient survival. Our data demonstrate the safety of MARS even in the most severely ill patients awaiting LT, but strategies that promote the more rapid and widespread availability of high-quality donor organs remain of critical importance for improving patient survival in cases of severe acute liver failure. Liver Transpl 21:369-380, 2015. V C 2015 AASLD.

The Art and Science of Diagnosing and Managing Drug-induced Liver Injury in 2015 and Beyond

“…Oral and IV formulations appear equally effective (246) The use of liver assist devices such as molecular adsorbent recirculating systems ( MARS) or plasma exchange have proven effective as a bridge to transplant, but remain largely investigational (68,69,(251)(252)(253). The role of nanotechnology to deliver hepatoprotective agents to the liver promise for the future (67).…”

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“…Randomized clinical trials using the Molecular Adsorbent Recirculating System (MARS) have shown significant dialysis effects with a considerable reduction in serum ammonia, bilirubin and bile acids along with a slight improvement in hepatic encephalopathy. However, all these large clinical trials have failed to demonstrate any survival benefit for the patients treated with MARS111213.…”

Hemadsorption with Adult CytoSorb® in a Low Weight Pediatric Case

“…MARS was applied for eight consecutive hours daily, every day, up until transplantation. All patients were mechanically ventilated and on vasopressors [10], as was the case in our patient. This method decreased serum ammonia and bilirubin [10].…”

“…Although MARS dialysis is the most extensively studied type of ELS, it is limited to case reports and small case series [10]. …”