Bridging to transplantation in acute liver failure in a 7-month-old infant

Trittenwein, Gerhard; Boigner, Harald; Mostafa, Gehan Ahmed; Burda, Gudrun; Mühl, Adolf; Amann, Gabriele; Pollak, Arnold

doi:10.1007/s00508-006-0580-7

Cited by 8 publications

(2 citation statements)

References 16 publications

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“…Beyond the removal of total bile acids, it was found that MARS induces a shift towards more hydrophilic bile acids in patients blood [33 ]. Aromatic amino acids are removed leading to an increase in Fischer's index [1,16 ]. The plasmatic nitric oxide, transported as a nitrosothiol by albumin, is of central importance in the typical haemodynamic changes of liver failure (hyperdynamic hypotension).…”

Section: Substance Removalmentioning

confidence: 99%

Albumin dialysis: an update

Mitzner

2007

Current Opinion in Nephrology and Hypertension

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Section: Substance Removalmentioning

confidence: 99%

Albumin dialysis: an update

Mitzner

2007

Current Opinion in Nephrology and Hypertension

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“…Consequently, it has been used to treat refractory pruritus, in adults as well as in children (5–7). While numerous studies have been published investigating the use of MARS therapy in adults, only limited pediatric experience has been reported in the literature (8–12). MARS therapy has been shown to improve the survival of adults with hepatorenal syndrome (13) and those with acute‐on chronic liver failure (3).…”

mentioning

confidence: 99%

Long‐lasting extracorporeal albumin dialysis in a child with end‐stage renal disease and severe cholestasis

Javouhey¹,

Ranchin²,

Lachaux³

et al. 2009

Pediatric Transplantation

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We report a case of long-lasting MARS therapy as a bridge to liver-kidney transplantation. A 26-month-old girl with congenital tubulointerstitial nephritis and severe liver fibrosis was placed on MARS for an acute-on-chronic liver failure due to sepsis. She underwent two sessions with good tolerance and recovered her previous neurological status. On the basis of pruritus, sleep, and vomiting improvement, repeated MARS sessions were performed to bridge her to combined liver-kidney transplantation. During eight months, 40 sessions were performed with the MARSmini kit and the MARS monitor (Gambro, Lyon, France). The treatment significantly decreased mean pruritus score from 2.2 +/- 0.9 to 0.8 +/- 0.6 night-time awakening and vomiting episodes. Body weight, height, and HC were -3.2, -3.5 and -2.2 SDS before and -1.7, -4.2, -2.0 SDS after eight months on MARS therapy, respectively. The arm circumference/HC ratio increased from 0.28 to 0.31. Mean total bilirubin serum levels were 303 +/- 72 micromol/L before and 214 +/- 42 micromol/L after MARS cycles. Long-lasting MARS dialysis is feasible in children, decreases adverse effects of severe chronic cholestasis, and may help to preserve nutritional status prior to combined liver-kidney transplantation.

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Artificial Liver Treatment, When and Which One?

Mitzner¹,

Grabow²,

Klammt³

2016

Contemporary Liver Transplantation

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Patients awaiting liver transplantation often are in critical condition with multi-organ failure accompanying the underlying liver disease. Stabilization and safe bridging of the patient to transplantation is a major indication for liver support methods. Various extracorporeal technologies have been tested clinically since the late 1950s. Currently, methods are divided into artificial, or nonbiological, systems based mainly on filtration and adsorption techniques and biological methods employing liver cells, typically of human, sometimes of animal origin. Examples of currently used liver support methods are the molecular adsorbent recirculating system (MARS) as an artificial system and the extracorporeal liver assist device (ELAD) as a biological liver-cell bioreactor. However, a considerable number of other approaches have been studied before or are currently under investigation. As of today, the best clinical experience exists for the MARS system. Liver support treatment should be considered early in the course of liver failure. Stabilization of various organ functions including circulatory, hepatic, and renal function, improvement of hepatic encephalopathy, and reduction of elevated intracranial pressure were observed in clinical studies. Modern extracorporeal liver support methods are safe to perform and a valuable addition to the therapeutic armamentarium of liver failure care.

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Bridging to transplantation in acute liver failure in a 7-month-old infant

Abstract: Albumin dialysis as described can be used successfully in infants < 1 year old for bridging to liver transplantation in cases of acute hepatic failure with deteriorating encephalopathy.

Cited by 8 publications

References 16 publications

Albumin dialysis: an update

Albumin dialysis: an update

Long‐lasting extracorporeal albumin dialysis in a child with end‐stage renal disease and severe cholestasis

Artificial Liver Treatment, When and Which One?

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