Mortality of patients with liver failure remains unacceptably high. As the liver has an enormous potential to regenerate, extracorporeal liver support devices may allow patients with liver failure to be bridged to recovery. Alternatively, liver assist may allow patients with advanced liver disease to be managed until a suitable organ for transplant is available. Current approaches to liver support include the use of biological devices that contain hepatocytes and those that function as detoxification devices, and artificial liver support systems. This review describes the current state of the art and existing data on the use of these devices to treat patients with liver failure.

Keywords:
Albumin dialysis, Liver support, Acute on chronic liver failure, Acute liver failure
1.
Jalan R, Williams R: Acute-on-chronic liver failure: pathophysiological basis of therapeutic options. Blood Purif 2002;20:252–261.
2.
Olson JC, Wendon JA, Kramer DJ, et al: Intensive care of the patient with cirrhosis. Hepatology 2011;54:1864–1872.
3.
Sen S, Davies NA, Mookerjee RP, et al: Pathophysiological effects of albumin dialysis in acute-on-chronic liver failure: a randomized controlled study. Liver Transpl 2004;10:1109–1119.
4.
Mookerjee RP, Stadlbauer V, Lidder S, et al: Neutrophil dysfunction in alcoholic hepatitis superimposed on cirrhosis is reversible and predicts the outcome. Hepatology 2007;46:831–840.
5.
Merrill JP, Thorn GW, Walter CW, et al: The use of an artificial kidney. 1. Technique. J Clin Invest 1950;29:412–424.
6.
Leckie P, Tritto G, Mookerjee R, et al: ‘Out-patient’ albumin dialysis for cholestatic patients with intractable pruritus. Aliment Pharmacol Ther 2012;35:696–704.
7.
Larsen F, Schmidt L, Wendon J, et al: Liver assisting with high volume plasma exchange in patients with acute liver failure. Hepatology 2010;52(suppl):376A.
8.
Kortgen A, Rauchfuss F, Gotz M, et al: Albumin dialysis in liver failure: comparison of molecular adsorbent recirculating system and single pass albumin dialysis – a retrospective analysis. Ther Apher Dial 2009;13:419–425.
9.
Banares R, Nevens F, Larsen FS, et al: Extracorporeal liver support with the molecular adsorbent recirculating system (MARS) in patients with acute-on-chronic liver failure. The RELIEF trial. J Hepatol 2010;52:A1184.
10.
Hassanein T, Blei AT, Perry W, et al: Performance of the hepatic encephalopathy scoring algorithm in a clinical trial of patients with cirrhosis and severe hepatic encephalopathy. Am J Gastroenterol 2009;104:1392–1400.
11.
Kribben A, Gerken G, Haag S, et al: Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure. Gastroenterology 2012;142:782–789.
12.
Rifai K, Ernst T, Kretschmer U, et al: Prometheus – a new extracorporeal system for the treatment of liver failure. J Hepatol 2003;39:984–990.
13.
Rozga J, Umehara Y, Trofimenko A, et al: A novel plasma filtration therapy for hepatic failure: preclinical studies. Ther Apher Dial 2006;10:138–144.
14.
Demetriou AA, Brown RS Jr, Hewitt RW, et al: Prospective, randomised, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Ann Surg 2004;239:660–667.
15.
Sauer IM, Kardassis D, Zeillinger K, et al: Clinical extracorporeal hybrid liver support – phase I study with primary porcine liver cells. Xenotransplantation 2003;10:460–469.
16.
Ellis AJ, Hughes RD, Wendon JA, et al: Pilot-controlled trial of the extracorporeal liver assist device in acute liver failure. Hepatology 1996;24:1446–1451.
17.
Zhong-Ping Duan JZ, Xin X, Chen JM, et al: Interim results of randomised controlled trial of ELAD in acute on chronic liver disease. Hepatology 2007;46:274A.
18.
Mazariegos GV, Patzer JF II, Lopez RC, et al: First clinical use of a novel bioartificial liver support system (BLSS). Am J Transplant 2002;2:260–266.
19.
Van de Kerkhove MP, Di Florio E, Scuderi V, et al: Phase I clinical trial with the AMC-bioartificial liver. Int J Artif Organs 2002;25:950–959.
20.
Sort P, Navasa M, Arroyo V, et al: Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403–409.
21.
Martin-Llahi M, Pepin MN, Guevara M, et al: Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology 2008;134:1352–1359.
22.
Jalan R, Schnurr K, Mookerjee RP, et al: Alterations in the functional capacity of albumin in patients with decompensated cirrhosis is associated with increased mortality. Hepatology 2009;50:555–564.
23.
Davies N, Proven A, Leckie P, et al: The development and testing of the UCL liver support device (UCL-ARSeNEL): improvement of survival in paracetamol-induced acute liver failure pigs. Hepatology 2010;52(suppl): 1092A.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.