[Evaluation of extracorporeal liver support systems in the treatment of liver failure. A systematic review].
OBJECTIVE
To evaluate the safety and efficacy of the MARS and Prometheus extracorporeal liver support systems in the treatment of liver failure.


METHODS
We performed a systematic review of the literature from January 1999 to June 2009 in the Medline, Embase, HTA, DARE, NHSEED, Cochrane Library Plus, Clinical Trials Registry and HSRPROJ databases. Study selection was based on a series of previously established inclusion criteria related to the study design, population, type of intervention, language, and outcome measures.


METHODS
Patients with acute liver failure or acute exacerbations of chronic liver failure treated with the MARS or Prometheus systems.


METHODS
Data on safety, long-term survival, clinical effects and biochemical and hemodynamic variables.


RESULTS
We selected 22 studies evaluating the safety and efficacy of the MARS and Prometheus systems. Adequate evaluation of these techniques was hampered by the heterogeneity of the studies and their methodological limitations.


CONCLUSIONS
Extracorporeal liver support systems are able to purify both hydrosoluble and protein-bound substances. However, current data show that only the MARS system reduces mortality in acute liver failure and in acute exacerbations of chronic liver failure, although this reduction is non-significant. These techniques can be considered safe, with adverse effects similar to those of the control group. Their main indication is severe liver failure, for short periods while the liver recovers or a liver transplant becomes available.
Atienza Merino
Gerardo
G
Agencia de Evaluación de Tecnologías Sanitarias de Galicia, Consellería de Sanidade, Xunta de Galicia, Galicia, España. gerardo.atienza.merino@sergas.es
D003956:Dialysis; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000191:economics / Q000941:ethics / Q000295:instrumentation; D006439:Hemodynamics; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods; D006801:Humans; D017093:Liver Failure / Q000097:blood / Q000401:mortality / Q000628:therapy*; D019164:Liver, Artificial / Q000009:adverse effects / Q000191:economics / Q000941:ethics; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D016060:Sorption Detoxification / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome