title: Extracorporeal liver support.
abstract: OBJECTIVE
  The mortality in patients suffering from liver failure decreased in line with medical progress over the past decades. However, it still remains unacceptably high and liver transplantation still provides the only definite treatment for many patients. The goal of extracorporeal liver support systems is to improve the clinical condition of patients waiting for liver transplantation and/or enhance the regeneration of native injured liver. Nonbiological liver support systems with pure detoxification and biological liver support systems with assumed synthesis and metabolism in addition to detoxification are currently under clinical investigation. Since patient survival is the most significant outcome parameter, we focus in this review on prospective randomized trials with survival rate as primary outcome parameter.
  
  
  RESULTS
  Although a short-term outcome benefit in patients with acute-on-chronic liver failure was shown in some of these trials, long-term outcome has not been improved significantly with either of the support systems. In spite of more favourable but yet limited data in patients with acute liver failure, it is too early to draw definite conclusions.
  
  
  CONCLUSIONS
  The future development of liver support systems may provide different combinations of new adsorbents, integrated regional citrate anticoagulation and eventual substitution of irreversibly damaged albumin.
authors: Department of Anesthesiology, General Intensive Care and Pain Therapy, Medical University of Vienna, Vienna, Austria. peter.faybik@meduniwien.ac.at
authors: Peter
authors: P
authors: Faybik
authors: Claus-Georg
authors: CG
authors: Krenn
mesh_terms: D000418:Albumins / Q000378:metabolism*; D000925:Anticoagulants / Q000627:therapeutic use*; D019343:Citric Acid / Q000627:therapeutic use*; D003956:Dialysis / Q000379:methods; D058625:End Stage Liver Disease / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D016060:Sorption Detoxification / Q000379:methods
chemical_list: D000418:Albumins; D000925:Anticoagulants; D019343:Citric Acid