Bourgoin Pierre, Merouani Aicha, Phan Véronique, Litalien Catherine, Lallier Michel, Alvarez Fernando, Jouvet Philippe
Pediatric Intensive Care Unit, Department of Pediatrics, Sainte-Justine Hospital, Montreal, QC, Canada.
Pediatr Nephrol. 2014 May;29(5):901-8. doi: 10.1007/s00467-013-2691-5. Epub 2013 Dec 6.
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(®)).
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.
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.
In our experience, treatment with MARS(®) is associated with encouraging results in adolescents, but it needs modification for very sick infants to improve tolerance.
对于患有急性肝衰竭（ALF）的儿童，将支持性治疗作为移植或康复的桥梁仍然具有挑战性。我们报告了我们使用分子吸附循环系统（MARS(®)）治疗儿童的经验。
本单中心回顾性研究纳入了2009年10月至2012年10月接受MARS(®)治疗的儿童的回顾性数据。记录患者特征、ALF的临床表现和并发症、每次MARS(®)治疗前后的临床和生物学数据、技术方式及不良事件。
在研究期间，共有6名儿童接受了17次MARS(®)治疗。2名青少年使用成人滤器MARSFLUX(®)进行治疗，4名婴儿使用MiniMARS(®)滤器进行治疗。入院时的平均儿科逻辑功能障碍（PELOD）评分为19分（范围为11 - 33分）。所有患者均接受机械通气，4例患有急性肾损伤。1例患者的神经病程改善，2例判定为稳定，1例恶化；2例数据缺失。MARS(®)治疗后，平均血清氨水平从初始的89±29显著降至58±35μmol/L（p = 0.02）。未观察到其他显著的生物学改善。青少年组的血流动力学状态改善/保持不变，但婴儿组7次治疗中有4次耐受性差，2次治疗中止。3例患者死亡，2例成功移植，1例未移植而康复。
根据我们的经验，MARS(®)治疗在青少年中取得了令人鼓舞的结果，但对于病情非常严重的婴儿，需要进行改进以提高耐受性。
