title: Molecular Absorbent Recirculating System therapy (MARS®) in pediatric acute liver failure: a single center experience.
abstract: BACKGROUND
  Supportive care as a bridge to transplant or recovery remains challenging in children suffering from acute liver failure (ALF). We report our experience in children using the Molecular Absorbent Recirculating System (MARS(®)).
  
  
  METHODS
  Retrospective data from children receiving therapy using MARS(®) from October 2009 to October 2012 were included in this single-center retrospective study. Patient characteristics, clinical presentation and complications of ALF, clinical and biological data before and after each MARS(®) session, technical modalities and adverse events were recorded.
  
  
  RESULTS
  A total of six children underwent 17 MARS(®) sessions during the study period. Two adolescents were treated with the adult filter MARSFLUX(®) and four infants were treated with the MiniMARS(®) filter. The mean PEdiatric Logistic Dysfunction (PELOD) score at admission was 19 (range 11-33). All patients were mechanically ventilated, and four had acute kidney injury. The neurological course improved in one case, judged as stable in two cases and worsened in one case; data were unavailable in two cases. Mean serum ammonia levels decreased significantly following treatment with MARS(®) from an initial 89 ± 29 to 58 ± 35 mcmol/L (p = 0.02). No other significant biological improvement was observed. Hemodynamic status improved/remained unchanged in the adolescent group, but in the infants four of the seven sessions were poorly tolerated and two sessions were aborted. Three patients died, two were successfully transplanted and one recovered without transplantation.
  
  
  CONCLUSIONS
  In our experience, treatment with MARS(®) is associated with encouraging results in adolescents, but it needs modification for very sick infants to improve tolerance.
authors: Pediatric Intensive Care Unit, Department of Pediatrics, Sainte-Justine Hospital, Montreal, QC, Canada.
authors: Pierre
authors: P
authors: Bourgoin
authors: Aicha
authors: A
authors: Merouani
authors: Véronique
authors: V
authors: Phan
authors: Catherine
authors: C
authors: Litalien
authors: Michel
authors: M
authors: Lallier
authors: Fernando
authors: F
authors: Alvarez
authors: Philippe
authors: P
authors: Jouvet
mesh_terms: D000293:Adolescent; D003422:Critical Care; D003956:Dialysis; D005260:Female; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D016060:Sorption Detoxification / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome