title: Comparison of Molecular Adsorbents Recirculating System (MARS) dialysis with combined plasma exchange and haemodialysis in children with acute liver failure.
abstract: BACKGROUND
  Molecular Adsorbents Recirculating System (MARS) is an extracorporeal liver support system eliminating albumin-bound and water-soluble substances. While it is increasingly applied in patients with acute liver failure (ALF), no comparison with standard dialysis methods has yet been performed.
  
  
  METHODS
  This is an analysis of ten children (0.1-18 years) with ALF, who underwent a total of 22 MARS sessions. Standard adult MARS sets were used in seven (23.5-72 kg) and MARS Mini in three children (2.8-13 kg). In eight children, MARS was alternated with combined plasma exchange (PE) and haemodialysis (HD) treatments. Mean treatment duration was 7.2 (6-10) h for MARS and 5.7 (4.5-6.6) h for PE/HD.
  
  
  RESULTS
  Standard MARS treatment only slightly decreased serum bilirubin (16.3 ± 6.5-13.8 ± 5.9 mg/dL) and ammonia (113 ± 62-99 ± 68 μmol/L) and international normalized ratio (INR) tended to increase (1.5 ± 0.3 and 2 ± 1.1). Mini-MARS did not reduce serum bilirubin (19.7 ± 3-20.5 ± 3.2 mg/dL), ammonia slightly decreased (70 ± 24-56 ± 9 μmol/L) and INR increased (2.5 ± 0.7-2.9 ± 1.1, all P = n.s.). In contrast, PE/HD reduced serum bilirubin (23 ± 8.4-14.7 ± 7 mg/dL), ammonia (120 ± 60-70 ± 40 μmol/L) and INR (2.4 ± 0.8-1.4 ± 0.1, all P < 0.05). Intraindividual comparison showed a slight increase in bilirubin by 2 ± 22% with MARS and a reduction by 37 ± 11% with PE/HD (P < 0.001 versus MARS) and a decrease in ammonia of 18 ± 27 and 39 ± 23% (P < 0.05). INR increased during MARS by 26 ± 41% and decreased with PE/HD by 37 ± 20% (P < 0.01). All treatment sessions were well tolerated. Five children died, including the three children treated with Mini-MARS.
  
  
  CONCLUSIONS
  Our experience suggests superior efficacy of combined PE/HD as compared to intermittent MARS therapy for treating ALF.
authors.affiliation: Department of General Pediatrics, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany.
authors.forename: Betti
authors.initials: B
authors.lastname: Schaefer
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
authors.forename: Guido
authors.initials: G
authors.lastname: Engelmann
authors.forename: Jochen
authors.initials: J
authors.lastname: Meyburg
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Heckert
authors.forename: Markus
authors.initials: M
authors.lastname: Zorn
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Schmitt
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005112:Extracorporeal Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000097:blood / Q000628:therapy*; D008297:Male; D010951:Plasma Exchange; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D016060:Sorption Detoxification; D055815:Young Adult