Application of Artificial Liver Support (MARS) after split-liver transplantation in an infant

Background: we report about the application of Molecular Adsorbents Recirculating System (MARS) for artificial liver support in an an infant with primary graft dysfunction after split-liver transplantation (TX) We want to discuss the practicability and efficacy of this method as ultimate treatment or bridging-therapy to re-transplantation.

Patients and methods: an infant of 15 months developed acute liver failure after bone marrow transplantation because of myeloproliferative disease. He underwent split-liver transplantation (transplantation of segments 2 and 3). Early after TX, the patient developed graft dysfunction with a significant increase of liver enzymes (asat from 1,16 to 20,76 µmol/s/l and alat from 3,74 to 13,72 µmol/s/l and bilirubin (from 264 to 705 µmol/l). MARS (Fa. Teraklin) in combination with hemofiltration was performed daily. We determined liver enzymes (asat, alat) and bilirubin before and after each application.

Results: The use of MARS lead to a significant decrease of bilirubin and liver enzymes (bilirubin from 705 to 195 µmol/l and asat 20,76 to 0,41 µmol/s/l and alat 13,72 to 0,93 µmol/ s/l). But there was no influence on parameters of function and liver synthesis.

The general condition of the patient improved leading to retransplantation 2 weeks after primary TX.

Conclusion: There are experiences with artificial liver support after liver transplantation. To our knowledge, this is the first report of MARS after liver transplantation in infants at all. In our case, it proved to be practicable. In combination with intensive care, it led to clinical stabilization and thus, to retransplantation of the patient.