title: Artificial extracorporeal liver support therapy in patients with severe liver failure.
abstract: Severe liver failure is common and carries a high mortality risk in patients with both acute and acute-on-chronic liver failure. The failing liver constitutes a medical emergency, and in many cases liver transplantation is the only definite treatment. Extracorporeal liver support can be employed as a strategy for bridging to transplantation or recovery. This article focuses on options for artificial (nonbiological) extracorporeal treatment: single-pass albumin dialysis, fractionated plasma separation and adsorption (Prometheus(®)) and the molecular adsorbent recirculatory system. Their different principles, potential advantages and indications are discussed. Despite proven biochemical efficacy, there are little data regarding clinical end points. Thus far, molecular adsorbent recirculatory system therapy in acute and acute-on-chronic liver failure showed no survival benefit compared with standard medical therapy. Prometheus therapy showed reduced mortality in subgroups of higher severity of disease compared with standard medical therapy. Nevertheless, the value of extracorporeal liver support remains to be corroborated by further clinical studies that include the optimal timing, mode, intensity and duration of this treatment.
authors.affiliation: Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353 Germany.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Rademacher
authors.forename: Michael
authors.initials: M
authors.lastname: Oppert
authors.forename: Achim
authors.initials: A
authors.lastname: Jörres
mesh_terms: D058625:End Stage Liver Disease / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D017114:Liver Failure, Acute / Q000503:physiopathology / Q000628:therapy*; D010956:Plasmapheresis; D006435:Renal Dialysis / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome