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Two adolescent cases of early use of Molecular Adsorbent Recirculating System for drug-induced fulminant hepatic failure

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주제분류소아과학

초록

Fulminant hepatic failure (FHF) is a rare but fatal disease with a 40%-80% mortality, often requiring liver transplantation, which is hard to perform in children. A therapeutic intervention alternative to liver transplantation is an extracorporeal artificial liver support system. Molecular Adsorbent Recirculation Systems􀋓 (MARS) has emerged as a bridge therapy for adult FHF, whereas in pediatric FHF, there have been a small number of cases of implementing MARS. Recently, we witnessed the recovery of 2 teenagers with FHFs caused by acetaminophen and a diet aid. Both patients were treated uneventfully, with early use of MARS. These cases suggest that early use of MARS may be a promising therapeutic intervention in pediatric drug-induced FHF.

Abstract

Fulminant hepatic failure (FHF) is a rare but fatal disease with a 40%-80% mortality, often requiring liver transplantation, which is hard to perform in children. A therapeutic intervention alternative to liver transplantation is an extracorporeal artificial liver support system. Molecular Adsorbent Recirculation Systems􀋓 (MARS) has emerged as a bridge therapy for adult FHF, whereas in pediatric FHF, there have been a small number of cases of implementing MARS. Recently, we witnessed the recovery of 2 teenagers with FHFs caused by acetaminophen and a diet aid. Both patients were treated uneventfully, with early use of MARS. These cases suggest that early use of MARS may be a promising therapeutic intervention in pediatric drug-induced FHF.

참고문헌 (9)

  1. Lutfi R, "Intensive care management of pediatric acute liver failure", J Pediatr Gastroenterol Nutr, 64, pp.660~670 (2017)
  2. Lee EJ, "Development of a prognostic score to predict mortality in patients with pediatric acute liver failure", J Pediatr Gastroenterol Nutr, 70, pp.777~782 (2020)
  3. Pham YH, "Liver transplantation in children", Clin Liver Dis, 22(4), pp.807~821 (2018)
  4. Bourgoin P, "Molecular absorbent recirculating system therapy(MARS®)in pediatric acute liver failure : a single center experience", Pediatr Nephrol, 29, pp.901~908 (2014)
  5. Wittebole X, "Use of the molecular adsorbent recirculating system(MARS™)for the management of acute poisoning with or without liver failure", Clin Toxicol(Phila), 49, pp.782~793 (2011)
  6. Cisneros-Garza LE, "The molecular adsorbent recirculating system as a liver support system : summary of Mexican experience", Ann Hepatol, 13, pp.240~247 (2014)
  7. Bailey B, "Fulminant hepatic failure secondary to acetaminophen poisoning : a systematic review and meta-analysis of prognostic criteria determining the need for liver transplantation", Crit Care Med, 31, pp.299~305 (2003)
  8. Zhou XM, "Clinical experience with molecular adsorbent recirculating system(MARS)in patients with drug-induced liver failure", Artif Organs, 28, pp.483~486 (2004)
  9. Beyls C, "Hemodynamic impact of molecular adsorbent recirculating system in refractory vasoplegic shock due to calcium channel blocker poisoning", Int J Artif Organs, 44, pp.944~951 (2021)

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