Acute exacerbations of chronic liver failure in the pediatric population require advanced ICU care in order to survive to transplantation (OLT). Often, the patients are on multiple modes of life support including mechanical ventilation, renal replacement therapy (RRT), and occasionally Molecular Absorbent Recirculating System (MARS) therapy. We aimed to show that MARS therapy in the pediatric population disenfranchises these patients from being listed as status 1B for liver transplantation.

We retrospectively reviewed our institutional experience of 63 pediatric OLT recipients from the ICU to identify those who had undergone MARS therapy. Patients who received MARS for indications other than acute exacerbation of chronic liver failure were excluded. The pre- and post-therapy Pediatric End-stage Liver Disease (PELD) scores were calculated.

Five patients met criteria for inclusion to our study. All patients were on multiple forms of life support in addition to MARS therapy. All patients had pre-MARS PELD scores of at least 25. With MARS therapy, the PELD score dropped to <25 in four patients. Despite the improvement in PELD scores with MARS therapy, mechanical ventilation and RRT were still required in all patients.

In order to be considered for status 1B listing, a patient must first have a PELD greater than 25. The PELD score is required to be updated every seven days to ensure a patient's candidacy for 1B status.

We demonstrate in our case series that MARS therapy decreased our patients' PELD scores to below criteria in for 1B listing in four out of five patients, without reducing the need for other forms of life support. In cases when therapy lasted longer than one week, treatments had to be briefly withheld to re-qualify for status 1B.

In conclusion, patients on MARS therapy who previously qualified for 1B listing should be granted exception to continue their 1B listing.

CITATION INFORMATION: Bakshi A, Kueht M, Rana A, Akcan Arikan A, Goss J. Children Listed as Status 1B for Liver Transplantation Are Disenfranchised by MARS Therapy. Am J Transplant. 2016;16 (suppl 3).

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