Liver transplantationCandidatePediatric Acute Liver Failure With Molecular Adsorbent Recirculating System Treatment
Section snippets
Patients and Methods
Since 2000 we performed 2027 MARS treatments in 190 patients including 39 affected by FHF. Since September 2004 we treated 6 pediatric patients with FHF who were of mean age 10.6 years (range, 3–15 years) including 4 females and 2 males. In 3 cases, the cause of FHF was unknown; in 2 cases, it was induced by paracetamol overdose; and 1, by acute hepatitis B virus.
Inclusion criteria for MARS treatments were: bilirubin >15 mg/dL; creatinine >2 mg/dL; encephalopathy grade >II; International
Results
Since September 2004 we treated 6 pediatric patients with the MARS liver support device as a bridging procedure to liver transplantation. Median waiting time was 3 days (range, 2–4 days). Among 6 patients, 3 children were transplanted: 1 who had experienced paracetamol overdose (patient A); 1, acute hepatitis B (patient B); and 1, unknown causes (patient C). Patients A and B are alive at 14 months follow-up; patient C died after 5 days due to primary nonfunction. In 2 children the MARS
Discussion
Over the last 2 decades, many static and dynamic variables have been proposed to assess prognosis in patients with FHF. The 3 most important components of ALF management are (1) identification of causes requiring specific treatment; (2) institution of early monitoring and optimal intensive care for multiorgan involvement to improve chances of spontaneous recovery or of transplantation (deteriorating encephalopathy with cerebral edema relates to a systemic inflammatory response—infections need
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