Liver support for fulminant hepatic failure: Is it time to use the Molecular Adsorbents Recycling System in children?*

Tissières, Pierre; Sasbón, Jorge S.; Devictor, Denis

doi:10.1097/01.pcc.0000170624.29667.7b

Cited by 41 publications

(11 citation statements)

References 69 publications

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“…Artificial extracorporeal liver support devices were designed to improve the survival of patients with ALF by carrying out the detoxification processes, in the form of bridge therapy, while awaiting transplantation [14]. …”

Section: Discussionmentioning

confidence: 99%

Hemadsorption with Adult CytoSorb® in a Low Weight Pediatric Case

Cîrstoveanu

Barascu

Stancu

2017

Case Reports in Critical Care

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Cytokine adsorber (CytoSorb) has been used successfully as adjunctive treatment for adult patients with elevated cytokine levels in the setting with severe sepsis and septic shock and to reduce blood myoglobin, unconjugated bilirubin, and conjugated bilirubin. In this article we present the case of a nine-month-old male infant who was admitted to the NICU due to sepsis after cardiac surgery, Fallot tetralogy, and multisystem organ failure (MSOF) including liver failure and renal failure which was successfully treated by a combination of continuous hemodiafiltration (HDF) and hemadsorption with CytoSorb. HDF was safe and effective from the first day for urea removal, but the patient's bilirubin levels kept increasing gradually, culminating on the 9th day with a maximum value of 54 mg/dL of total bilirubin and 31.67 mg/dL of direct bilirubin when we performed hemadsorption with CytoSorb. Over the 49-hour period of hemadsorption, the total bilirubin value decreased from 54 to 14 mg/dL, and the patient's general status improved considerably accompanied by a rapid drop of aminotransferases. Hemodynamic status has been improved as well and inotropes dropped rapidly. The patient's ventilation settings improved during CytoSorb treatment permitting weaning the patient from mechanical ventilation after five days of hemadsorption. The patient was discharged home after 34 days of hospitalization, in a good general status.

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Section: Discussionmentioning

confidence: 99%

Hemadsorption with Adult CytoSorb® in a Low Weight Pediatric Case

Cîrstoveanu

Barascu

Stancu

2017

Case Reports in Critical Care

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“…It is based on the principles of dialysis, filtration, and adsorption. A systematic review published last year concluded that liver support systems do not significantly affect mortality when compared with conventional medical therapy in children [44]. Another study involved 13 patients treated with MARS, with overall mortality of 85% in a setting without timely liver transplantation [45].…”

Section: Liver Support Systemsmentioning

confidence: 98%

Epidemiology of acute liver failure

Khashab

Tector

Kwo

2007

Curr Gastroenterol Rep

128

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Acute liver failure (ALF) is an uncommon disorder that leads to jaundice, coagulopathy, and multisystem organ failure. Its definition is based on the timing from onset of jaundice to encephalopathy. In 2005, ALF accounted for 6% of liver-related deaths and 7% of orthotopic liver transplants (OLT) in the United States. Several classification systems have been developed for ALF, with the King's College criteria most widely used for prediction of OLT. Specific diagnostic tests should be implemented to identify the cause of ALF, which will help to determine its treatment and prognosis. Viral hepatitis was previously reported to be the most common cause of ALF in the United States, but acetaminophen overdose and idiosyncratic drug reactions have emerged as the most frequent causes in recent studies. Malignancy is an uncommon cause of ALF, and thus imaging studies may not be useful in this setting, but liver biopsy may be beneficial in selected cases. An overall strategy for ALF should start with identifying the cause, assessing the prognosis, and early transfer to a transplantation center for suitable candidates. OLT has emerged as a life-saving procedure leading to marked improvement in survival rates. Improved surgical techniques, immunosuppression, and comprehensive care have led to an overall survival rate of approximately 65% with OLT. N-acetylcysteine is effective in ALF caused by acetaminophen overdose, with results strongly related to how soon it is given rather than the route of administration. Liver support systems show potential for the treatment of ALF, but their role needs validation in large multicenter randomized trials.

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“…[5][6][7] Extracorporeal liver support (ELS) is designed to improve the survival of patients with severe liver failure by replacing the detoxification function of the liver and thereby creating a bridge to transplantation. 8 ELS modalities include the fractionated plasma separation, adsorption, and dialysis system (Prometheus), 9,10 single-pass albumin dialysis, 11 and Molecular Adsorbent Recirculating System (MARS) albumin dialysis, which was introduced by Stange and Mitzner in the 1990s. [12][13][14] In 1999, MARS was shown to be effective in the clearance of protein-bound and water-soluble toxins and to have a positive effect on hepatic encephalopathy (HE) in 13 adult patients with acute-on-chronic liver failure (ACLF).…”

Section: See Editorial On Page 277mentioning

confidence: 99%

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

et al. 2015

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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.

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Liver support for fulminant hepatic failure: Is it time to use the Molecular Adsorbents Recycling System in children?*

Cited by 41 publications

References 69 publications

Hemadsorption with Adult CytoSorb® in a Low Weight Pediatric Case

Hemadsorption with Adult CytoSorb® in a Low Weight Pediatric Case

Epidemiology of acute liver failure

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

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