Background. The prognosis of pediatric acute liver failure (PALF) has been significantly improved by emergency orthotopic liver transplantation (OLT). Since 2004, the molecular adsorbent recirculating system (MARS) has been proposed as a bridging procedure. The aim of our study was to assess its efficacy in children with PALF. Patients and Methods. Since 1999 we performed treatment of 39 fulminant hepatic failure (FHF) cases with MARS. 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 in 1, by acute hepatitis B virus. Inclusion criteria were: bilirubin 15 mg/dL; creatinine 2 mg/dL; encephalopathy grade II; and International normalized ratio (INR) 2.5. Other estimated parameters were: AST and ALT serum levels, lactate, and urine volume. Neurological status was monitored using the Glasgow Coma Scale (GCS). Continuous MARS treatment was performed in all patients with a kit change every 8 hours. Intensive care unit (ICU) treatment was applied to optimize regeneration and to prevent cardiovascular complications. Results. We observed a significant improvement among levels of bilirubin (P .009), ammonia (P .005), creatinine (P .02), GCS (P .002), and predictive criteria and as Sequential Organ Failure Assessment (SOFA) and Pediatric End-Stage Liver Disease (PELD). Three children underwent OLT: 1 died after 5 days due to primary nonfunction and 2 children are alive after a median follow-up of 14 months. In 2 children the MARS treatment led to resolution of clinical status without liver transplantation. One child died before OLT due to sepsis and multiorgan failure. Conclusions. We concluded that application of the MARS liver support device in combination with experienced ICU management contributed to improve the clinical status in children with PALF awaiting liver transplantation.
Pediatric acute liver failure with molecular adsorbent recirculating system treatment / Novelli, Gilnardo; Rossi, Massimo; Morabito, VINCENZO EMILIANO; Pugliese, Francesco; Ruberto, F.; Perrella, S. M.; Novelli, S.; Spoletini, G.; Ferretti, GIAN CARLO; Mennini, Gianluca; Berloco, Pasquale Bartolomeo. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 40:6(2008), pp. 1921-1924. (Intervento presentato al convegno 31st Congress of the Italian-Transplantation-Society tenutosi a Modena, ITALY nel NOV 28-30, 2007) [10.1016/j.transproceed.2008.05.075].
Pediatric acute liver failure with molecular adsorbent recirculating system treatment
NOVELLI, Gilnardo;ROSSI, MASSIMO;MORABITO, VINCENZO EMILIANO;PUGLIESE, Francesco;F. Ruberto;S. Novelli;FERRETTI, GIAN CARLO;MENNINI, Gianluca;BERLOCO, Pasquale Bartolomeo
2008
Abstract
Background. The prognosis of pediatric acute liver failure (PALF) has been significantly improved by emergency orthotopic liver transplantation (OLT). Since 2004, the molecular adsorbent recirculating system (MARS) has been proposed as a bridging procedure. The aim of our study was to assess its efficacy in children with PALF. Patients and Methods. Since 1999 we performed treatment of 39 fulminant hepatic failure (FHF) cases with MARS. 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 in 1, by acute hepatitis B virus. Inclusion criteria were: bilirubin 15 mg/dL; creatinine 2 mg/dL; encephalopathy grade II; and International normalized ratio (INR) 2.5. Other estimated parameters were: AST and ALT serum levels, lactate, and urine volume. Neurological status was monitored using the Glasgow Coma Scale (GCS). Continuous MARS treatment was performed in all patients with a kit change every 8 hours. Intensive care unit (ICU) treatment was applied to optimize regeneration and to prevent cardiovascular complications. Results. We observed a significant improvement among levels of bilirubin (P .009), ammonia (P .005), creatinine (P .02), GCS (P .002), and predictive criteria and as Sequential Organ Failure Assessment (SOFA) and Pediatric End-Stage Liver Disease (PELD). Three children underwent OLT: 1 died after 5 days due to primary nonfunction and 2 children are alive after a median follow-up of 14 months. In 2 children the MARS treatment led to resolution of clinical status without liver transplantation. One child died before OLT due to sepsis and multiorgan failure. Conclusions. We concluded that application of the MARS liver support device in combination with experienced ICU management contributed to improve the clinical status in children with PALF awaiting liver transplantation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
