title: Extracorporeal liver support devices for listed patients.
abstract: An alternative to liver transplantation for patients with liver failure remains an unmet need. In acute liver failure, the ideal extracorporeal liver support device (ELSD) would replace the functions of the failing liver in order to permit spontaneous recovery, given the incredible regenerative potential of the liver, negating the need for transplantation. In acute-on-chronic liver failure, an ELSD would ideally support hepatic function until a recovery to liver function before acute decompensation or until liver transplantation. In decompensated cirrhosis, an ELSD could again be used to support hepatic function until transplant. In addition, ELSDs may have the potential to treat the multiorgan failure that accompanies liver failure including hepatic encephalopathy, renal failure, and immune dysfunction or indeed potential to promote liver regeneration. Creation of an extracorporeal bioartificial liver able to completely replace liver function remains an unmet need. This review will describe a number of technologies suitable for clinical trials in humans, which have resulted from decades of engineering and biological research to develop a bioreactor able to adequately sustain functional hepatocytes. In addition, this review will describe artificial liver support devices that are primarily designed to replace the detoxifying functions of the liver and will consider the current data available or studies required to support their use in liver failure patients on the transplant waiting list. Liver Transplantation 22 839-848 2016 AASLD.
authors.affiliation: Department of Clinical Science and Services, The Royal Veterinary College, Hertfordshire, UK.
authors.forename: Karla C L
authors.initials: KC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Stadlbauer
authors.affiliation: Liver Failure Group, Institute for Liver and Digestive Health, University College London Medical School Royal Free Campus, London, UK.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jalan
mesh_terms: D019149:Bioreactors; D002986:Clinical Trials as Topic; D003956:Dialysis / Q000295:instrumentation / Q000379:methods; D022781:Hepatocytes / Q000502:physiology; D006801:Humans; D008099:Liver / Q000166:cytology / Q000502:physiology*; D017093:Liver Failure / Q000401:mortality / Q000628:therapy*; D008115:Liver Regeneration; D016031:Liver Transplantation / Q000009:adverse effects*; D019164:Liver, Artificial; D010951:Plasma Exchange / Q000379:methods* / Q000706:statistics & numerical data; D051437:Renal Insufficiency / Q000628:therapy*; D014850:Waiting Lists / Q000401:mortality