| Abstract: | Background: Acute liver failure (ALF) as a result of mushroom poisoning is associated with a high mortality (particularly in children), despite optimal medical therapy (OMT), including charcoal haemoperfusion and haemodiafiltration. MARS is a new, cell‐free, extracorporeal liver assistance method utilizing an albumin dialysate for the removal of albumin‐bound toxins. Methods: We describe the first series in the literature (also first MARS treatments in Romania) with ALF because of mushroom poisoning in children (M/F = 2/4, age = 7–16 years). Liver function was evaluated pre‐MARS and 15‐min post‐MARS, 24 h following each treatment and 30 days post‐MARS. Findings: All patients had severe hepatic dysfunction: hepatic encephalopathy (HE; four grade II, one grade III, one grade IV), ALT = 4082 (3400–5600) IU/L, bilirubin = 6.3 2 - 10 ) mg/dL, prothrombin time (PT) = 52.5 (23–141) s. MARS was uneventful and well‐tolerated. Two 6‐h sessions per patient were performed with a similar immediate impact on liver tests: mean drop in ALT of ?33 and ?35%, respectively, and in bilirubin of ?39 and ?36%, respectively. ALT levels 24 h following MARS‐1, remained unchanged but continued to drop by a further ?28% following MARS‐2. By contrast, all patients had a significant rebound in bilirubin (+39%) 24 h following MARS‐1; however, following MARS‐2 a rebound was seen only in two cases (+220%). PT improved by 37% after MARS‐1 and normalized in four patients after MARS‐2. Outcome: Four patients survived and completely recovered the hepatic function. Negative prognostic markers: lack of complete correction of PT, continuous rebound and increase in bilirubin, and lack of improvement in HE post‐MARS‐1. Survival in six well‐matched cases, treated by OMT = 0/6 (P < 0.05). Conclusions: MARS is a safe and highly effective depurative therapy in children with ALF. Survival is predicted only by the impact/results of the initial MARS sessions and not by any of the baseline parameters. |
