Skip to main content
SpringerLink
Log in

Extracorporeal Liver Replacement Therapy for Pediatric Patients

  • Chapter
  • First Online:
Pediatric Dialysis

  • 1911 Accesses

Abstract

Acute liver failure (ALF) is a rare but life-­threatening disorder in children. The spectrum of etiologies varies with age: Metabolic disorders predominate in infants, followed by neonatal hemochromatosis. In older children ALF is caused by viral hepatitis in 40% and by drug intoxication in 10%, while the etiology remains obscure in almost 50% of cases [1]. While one third of children recover with supportive management [2], the other two third require emergency liver transplantation. Likewise, the majority of children with acute-on-chronic liver failure and those with progressive chronic liver disease require liver transplantation. Since organ availability is limited and considerable bridging time may be required, extracorporeal liver support therapies are increasingly applied.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Cochran JB, Losek JD. Acute liver failure in children. Pediatr Emerg Care. 2007;23(2):129–35.

    Article  PubMed  Google Scholar 

  2. Lee WS, McKiernan P, Kelly DA. Etiology, outcome and prognostic indicators of childhood fulminant hepatic failure in the United Kingdom. J Pediatr Gastroenterol Nutr. 2005;40(5):575–81.

    Article  PubMed  Google Scholar 

  3. Mitzner SR, Stange J, Klammt S, Risler T, Erley CM, Bader BD, Berger ED, Lauchart W, Peszynski P, Freytag J, Hickstein H, Loock J, Löhr JM, Liebe S, Emmrich J, Korten G, Schmidt R. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial. Liver Transpl. 2000;6(3): 277–86.

    Article  PubMed  CAS  Google Scholar 

  4. Heemann U, Treichel U, Loock J, Philipp T, Gerken G, Malago M, Klammt S, Loehr M, Liebe S, Mitzner S, Schmidt R. Stange J albumin dialysis in cirrhosis with superimposed acute liver injury: a prospective, controlled study. Hepatology. 2002;36(4 Pt 1):949–58.

    PubMed  CAS  Google Scholar 

  5. Khuroo MS, Farahat KL. Molecular adsorbent recirculating system for acute and acute-on-chronic liver failure: a meta-analysis. Liver Transplant. 2004;10(9): 1107–8.

    Article  Google Scholar 

  6. Ash SR. Extracorporeal blood detoxification by sorbents in treatment of hepatic encephalopathy. Adv Ren Replace Ther. 2002;9(1):3–18.

    Article  PubMed  Google Scholar 

  7. Gong D, Ji D, Ren B, Tao J, Xu B, Ronco C, Li L. Significant decrease in dialysate albumin concentration during molecular adsorbent recirculating system (MARS) therapy. Int J Artif Organs. 2008;31(4):333–9.

    PubMed  CAS  Google Scholar 

  8. Faybik P, Bacher A, Kozek-Langenecker SA, et al. Molecular adsorbent recirculating system and hemostasis in patients at high risk of bleeding: an observational study. Crit Care. 2006;10(1):2.

    Article  Google Scholar 

  9. Bachli EB, Schuepbach RA, Maggiorini M, Stocker R, Müllhaupt B, Renner EL. Artificial liver support with the molecular adsorbent recirculating system: activation of coagulation and bleeding complications. Liver Int. 2007;27(4):475–84.

    Article  PubMed  CAS  Google Scholar 

  10. Doria C, Mandalà L, Smith JD, et al. Thromboelastography used to assess coagulation during treatment with molecular adsorbent recirculating system. Clin Transplant. 2004;18(4):365–71.

    Article  PubMed  Google Scholar 

  11. Rosa Diez G, Greloni G, Gadano A, Giannasi S, Crucelegui M, Trillini M, Algranati S. Combined extended haemodialysis with single-pass albumin dialysis (SPAED). Nephrol Dial Transplant. 2007; 22(9):2731–2.

    Article  PubMed  Google Scholar 

  12. Ash SR, Blake DE, Carr DJ, Carter C, Howard T. Makowka L clinical effects of a sorbent suspension dialysis system in treatment of hepatic coma (the BioLogic-DT). Int J Artif Organs. 1992;15(3): 151–61.

    PubMed  CAS  Google Scholar 

  13. Ash SR, Blake DE, Carr DJ, Carter C, Howard T. Makowka L neurologic improvement of patients with hepatic failure and coma during sorbent suspension dialysis. ASAIO Trans. 1991;37(3):M332–4.

    PubMed  CAS  Google Scholar 

  14. Demetriou AA, Brown Jr RS, Busuttil RW, Fair J, McGuire BM, Rosenthal P, Am Esch 2nd JS, Lerut J, Nyberg SL, Salizzoni M, Fagan EA, de Hemptinne B, Broelsch CE, Muraca M, Salmeron JM, Rabkin JM, Metselaar HJ, Pratt D, De La Mata M, McChesney LP, Everson GT, Lavin PT, Stevens AC, Pitkin Z, Solomon BA. Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Ann Surg. 2004;239(5):660–7.

    Article  PubMed  Google Scholar 

  15. Ellis AJ, Hughes RD, Wendon JA, Dunne J, Langley PG, Kelly JH, Gislason GT, Sussman NL. Williams R pilot-controlled trial of the extracorporeal liver assist device in acute liver failure. Hepatology. 1996;24(6): 1446–51.

    Article  PubMed  CAS  Google Scholar 

  16. Steiner C, Mitzner S. Experiences with MARS liver support therapy in liver failure: analysis of 176 patients of the international MARS registry. Liver. 2002;22(Suppl 2):20–5.

    PubMed  CAS  Google Scholar 

  17. Sorkine P, Ben Abraham R, Szold O, Biderman P, Kidron A, Merchav H, Brill S, Oren R. Role of the molecular adsorbent recycling system (MARS) in the treatment of patients with acute exacerbation of chronic liver failure. Crit Care Med. 2001;29(7): 1332–6.

    Article  PubMed  CAS  Google Scholar 

  18. Novelli G, Rossi M, Pretagostini M, Pugliese F, Ruberto F, Novelli L, Nudo F, Bussotti A, Corradini S, Martelli S. Berloco PB One hundred sixteen cases of acute liver failure treated with MARS. Transplant Proc. 2005;37(6):2557–9.

    Article  PubMed  CAS  Google Scholar 

  19. Hassanein TI, Tofteng F, Brown Jr RS, McGuire B, Lynch P, Mehta R, Larsen FS, Gornbein J, Stange J, Blei AT. Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis. Hepatology. 2007;46(6): 1853–62.

    Article  PubMed  CAS  Google Scholar 

  20. Jalan R, Sen S, Steiner C, Kapoor D, Alisa A, Williams R. Extracorporeal liver support with molecular adsorbents recirculating system in patients with severe acute alcoholic hepatitis. J Hepatol. 2003;38(1):24–31.

    Article  PubMed  CAS  Google Scholar 

  21. Schmidt LE, Svendsen LB, Sørensen VR, Hansen BA, Larsen FS. Cerebral blood flow velocity increases during a single treatment with the molecular adsorbents recirculating system in patients with acute on chronic liver failure. Liver Transplant. 2001;7(8): 709–12.

    Article  CAS  Google Scholar 

  22. Rifai K, Ernst T, Kretschmer U, Bahr MJ, Schneider A, Hafer C, Haller H, Manns MP. Fliser D prometheus – a new extracorporeal system for the treatment of liver failure. J Hepatol. 2003;39(6):984–90.

    Article  PubMed  CAS  Google Scholar 

  23. Skwarek A, Grodzicki M, Nyckowski P, Kotulski M, Zieniewicz K, Michalowicz B, Patkowski W, Grzelak I, Paczkowska A, Giercuszkiewicz D, Sańko-Resmer J, Paczek L. Krawczyk M the use of prometheus FPSA system in the treatment of acute liver failure: preliminary results. Transplant Proc. 2006;38(1):209–11.

    Article  PubMed  CAS  Google Scholar 

  24. Dethloff T, Tofteng F, Frederiksen HJ, Hojskov M, Hansen BA, Larsen FS. Effect of prometheus liver assist system on systemic hemodynamics in patients with cirrhosis: a randomized controlled study. World J Gastroenterol. 2008;14(13):2065–71.

    Article  PubMed  Google Scholar 

  25. Krisper P, Haditsch B, Stauber R, Jung A, Stadlbauer V, Trauner M, Holzer H. Schneditz D in vivo quantification of liver dialysis: comparison of albumin dialysis and fractionated plasma separation. J Hepatol. 2005;43(3):451–7.

    Article  PubMed  CAS  Google Scholar 

  26. Chawla LS, Georgescu F, Abell B, Seneff MG. Kimmel PL modification of continuous venovenous hemodiafiltration with single-pass albumin dialysate allows for removal of serum bilirubin. Am J Kidney Dis. 2005;45(3):e51–6.

    Article  PubMed  Google Scholar 

  27. Koball S, Hickstein H, Gloger M, Hinz M, Henschel J, Stange J. Mitzner S treatment of thyrotoxic crisis with plasmapheresis and single pass albumin dialysis: a case report. Artif Organs. 2010;34(2):E55–8.

    Article  PubMed  Google Scholar 

  28. Awad SS, Sawada S, Soldes OS, Rich PB, Klein R, Alarcon WH, Wang SC. Bartlett RH Can the clearance of tumor necrosis factor alpha and interleukin 6 be enhanced using an albumin dialysate hemodiafiltration system? ASAIO J. 1999;45(1):47–9.

    Article  PubMed  CAS  Google Scholar 

  29. Karvellas CJ, Bagshaw SM, McDermid RC, Stollery DE, Bain VG. Gibney RT a case-control study of single-pass albumin dialysis for acetaminophen-induced acute liver failure. Blood Purif. 2009;28(3):151–8.

    Article  PubMed  CAS  Google Scholar 

  30. Collins KL, Roberts EA, Adeli K, Bohn D. Harvey EA single pass albumin dialysis (SPAD) in fulminant Wilsonian liver failure: a case report. Pediatr Nephrol. 2008;23(6):1013–6.

    Article  PubMed  Google Scholar 

  31. Sauer IM, Goetz M, Steffen I, Walter G, Kehr DC, Schwartlander R, Hwang YJ, Pascher A, Gerlach JC. Neuhaus P in vitro comparison of the molecular adsorbent recirculation system (MARS) and single-pass albumin dialysis (SPAD). Hepatology. 2004;39(5):1408–14.

    Article  PubMed  CAS  Google Scholar 

  32. Peszynski P, Klammt S, Peters E, Mitzner S, Stange J, Schmidt R. Albumin dialysis: single pass vs. recirculation (MARS). Liver. 2002;22(Suppl 2):40–2.

    PubMed  CAS  Google Scholar 

  33. Kortgen A, Rauchfuss F, Götz M, Settmacher U, Bauer M, Sponholz C. Albumin dialysis in liver failure: comparison of molecular adsorbent recirculating system and single pass albumin dialysis – a retrospective analysis. Ther Apher Dial. 2009;13(5):419–25.

    Article  PubMed  CAS  Google Scholar 

  34. Klammt S, Koball S, Hickstein H, Gloger M, Henschel J, Mitzner S, Stange J. Reisinger EC increase of octanoate concentrations during extracorporeal albumin dialysis treatments. Ther Apher Dial. 2009;13(5):437–43.

    Article  PubMed  CAS  Google Scholar 

  35. Meijers BK, Verhamme P, Nevens F, et al. Major coagulation disturbances during fractionated plasma separation and adsorption. Am J Transplant. 2007; 7(9):2195–9.

    Article  PubMed  CAS  Google Scholar 

  36. Schaefer B, Schaefer F, Engelmann G, Meyburg J, Heckert KH, Zorn M, Schmitt CP. Comparison of Molecular Adsorbents Recirculating System (MARS) dialysis with combined plasma exchange and haemodialysis in a children with acute liver failure. Nephrol Dial Transplant. 2011 Mar 18. [Epub ahead of print].

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Pediatrics, Center for Pediatric and Adolescent Medicine, Pediatric Nephrology Division, Heidelberg, Germany

    Claus Peter Schmitt MD

  2. Pediatric Nephrology Division, Heidelberg University Hospital, Heidelberg, Germany

    Franz Schaefer MD

Authors
  1. Claus Peter Schmitt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Franz Schaefer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claus Peter Schmitt MD .

Editor information

Editors and Affiliations

  1. Children’s Mercy Hospital and Clinics, Department of Pediatrics, Section of Pediatric Nephrology, School of Medicine, Kansas City, 64108, Missouri, USA

    Bradley A. Warady

  2. Center for Pediatrics, and Adolescent Medicine, Division of Pediatric Nephrology, Im Neuenheimer Feld 150, Heidelberg, 69120, Germany

    Franz Schaefer

  3. Department of Pediatrics, Stanford University School of Medicine, Division of Pediatric Nephrology, Welch Road 770, Palo Alto, 94304, California, USA

    Steven R. Alexander

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Schmitt, C.P., Schaefer, F. (2012). Extracorporeal Liver Replacement Therapy for Pediatric Patients. In: Warady, B., Schaefer, F., Alexander, S. (eds) Pediatric Dialysis. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-0721-8_39

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-0721-8_39

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4614-0720-1

  • Online ISBN: 978-1-4614-0721-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation