Molecular Adsorbent Recirculating System (MARS) in Pediatric Patients

Background: The Molecular Adsorbent Recirculating System (MARS®) uses an albumin enriched dialysis solution to remove protein-bound molecules that are not removed by conventional renal replacement therapy. Its use was approved in the United States for management of drug overdose and intoxication. Other proposed indications include acute liver failure and Data regarding the efficacy of MARS® in pediatric patients remain scarce. Methods: Retrospective analysis of patients who received MARS® therapy at Cincinnati Children's Hospital Medical Center between January 1st, 2018 and November 30th, 2020. Collected data included age, sex, laboratory data, medical history, vascular catheter size, specifics of therapy, complications, and outcomes. Data existing in the electronic medical record were transcribed by investigators into a secure database. Results: 17/25 patients demonstrated at least one sign of clinical improvement. 13/22 patients experienced improvement in encephalopathy. 6/20 patients demonstrated hepatic recovery. 6/18 patients experienced renal recovery. 4/21 patients underwent liver transplant. 16/25 patients survived until ICU discharge. Youngest patient to receive MARS® was 29 days old. Lowest weight was 2.1 kilograms. Conclusion: We provide data on pediatric patients receiving MARS® at a high-volume tertiary care center. To our knowledge, this is the largest study on pediatric MARS® to date. We plan to expand this analysis to include data from 2014 – 2018 and 2020 – 2024. - Demographics Media(IQR) or N Unique Patients 23 Courses of Treatment 25 # of Procedures 83 Age 13.2 years (3.8, 17.9) Weight 41.7 kg (18.6, 60.3) Sex Males: 12Females: 13 Invasive Mechanical Ventilation at Initiation Yes: 14No: 10 Multiorgan Dysfunction at Initiation Yes: 21No: 4 CRRT at Initiation Yes: 17No: 8 Anticoagulation Citrate: 57Heparin: 18None: 8