title: Systematic review: extracorporeal bio-artificial liver-support system for liver failure.
abstract: BACKGROUND
  Orthotopic liver transplantation (OLT) is the only effective long-term treatment for liver failure by now. However, it is not yet a perfect choice due to donor-organ shortage and the need of a lifelong immunosuppressive therapy. Therefore, it is necessary to find a new approach to fighting the disease. Several published clinical trials have reported the therapeutic effect of bio-artificial liver (BAL) for liver failure.
  
  
  OBJECTIVE
  To overview and evaluate the current clinical application and outcomes of extracorporeal BAL support system during the past 15 years.
  
  
  METHODS
  Relevant studies were retrieved from PubMed and Cochrane Library databases. Independent assessments and the final consensus decision were performed by three independent reviewers. Acceptable study designs included randomized controlled trials, controlled clinical trials, and case reports. A total of 31 studies were tabulated and critically appraised in terms of characteristics, methods, and outcomes.
  
  
  RESULTS
  There was a trend of falling into the normal ranges with the clinical and biochemical parameters after the BAL treatment. The neurological status of most patients was improved or stabilized during BAL treatment as well. No significant effect on survival could be seen after the BAL treatment.
  
  
  CONCLUSIONS
  Although BAL system proved to be a success in some clinical cases reported, it still needs to be improved greatly.
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China.|Jiangsu Province's Key Medical Center for Hepatobiliary Disease, Nanjing, China.
authors.forename: Jinyang
authors.initials: J
authors.lastname: Gu
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China.|Jiangsu Province's Key Medical Center for Hepatobiliary Disease, Nanjing, China.
authors.forename: Xiaolei
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China.
authors.forename: Haozhen
authors.initials: H
authors.lastname: Ren
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China.|Jiangsu Province's Key Medical Center for Hepatobiliary Disease, Nanjing, China.
authors.forename: Qingxiang
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Department of Hepatobiliary Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China.
authors.forename: Jiangqiang
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China. yitaoding@hotmail.com.|Jiangsu Province's Key Medical Center for Hepatobiliary Disease, Nanjing, China. yitaoding@hotmail.com.
authors.forename: Yitao
authors.initials: Y
authors.lastname: Ding
keywords: Bio-artificial liver; Clinical trial; Liver failure; Systematic review